v3 Chapter 939： Mechanical complications after myocardial infarction!

Lu Chen hurried back to the cardiology ward.

At this time, both Gu Xinyue and Jin Miao were waiting at CCU.

As soon as he entered the gate of CCU, Jin Miao handed over the mask and hat.

"Director, you are finally here!"

Lu Chen looked serious, "What patient, why are you so nervous?"

Jin Miao and Gu Xinyue have been independent for so many years.

General patients, they are not so nervous at all.

Jin Miao calmed down his emotions and said solemnly, "It's a patient who was transferred from the First Hospital of the Magic City. They couldn't handle it, so they transferred it to us."

"It's the No. 1 Courtyard of the Magic Capital again?" Lu Chen was stunned for a moment.

The cardiology departments of other hospitals in the entire Modu will transfer patients to them intermittently.

It seems... The Fifth Hospital of the Magic City is regarded as the "last stop" for patients.

Everyone gradually formed a way of thinking.

That is, if it is a patient who has been declared "death penalty" by the Fifth Academy of the Magic City, then there is basically no hope.

Even if you transfer to Kyoto again, there will be no salvation.

If the patient was sentenced to "death penalty" in another hospital, but the Fifth Hospital of the Magic City said it could be saved, it means that there is still a glimmer of hope!

"Director Lu, there's nothing you can do. For this kind of critically ill patient, other hospitals in Modu forgot to transfer to our side."

Jin Miao couldn't help but complain.

"Okay, let's talk about this later." Lu Chen said, "Let's talk about the patient's condition first."

"it is good."

Jinmiao opened the mouth while leading the way.

"The patient is a 62-year-old woman who was hospitalized in the First Hospital of Modu for 1 week due to chest pain and chest tightness."

"After hospitalization, emergency coronary angiography was performed with complete occlusion of the circumflex branch, and acute lateral myocardial infarction was diagnosed. Stent was implanted in the circumflex branch. After the operation, the patient experienced recurrent acute heart failure, pulmonary exudation and infection."

"Re-examination of cardiac ultrasound after operation showed the formation of aneurysm in the lateral wall of the left ventricle, rupture and prolapse of the chordae tendineae of the anterior mitral valve and severe regurgitation."

Hearing this, Lu Chen's expression became more serious.

After acute myocardial infarction, rupture of the musculature or chordae tendineae is a serious mechanical complication after myocardial infarction.

This complication, which often leads to severe pulmonary edema and cardiogenic shock, is closely associated with poor prognosis.

Some studies have reported that in patients with severe mitral regurgitation caused by muscle rupture, the in-hospital mortality rate is as high as 70-80%!

However, there are contraindications to surgery because of its often unstable hemodynamics, severe comorbidities, and extremely high risk of surgery.

"The patient should have no chance of surgery, right?" Lu Chen asked.

Jin Miao nodded and said, "

The patient has severe heart failure and many underlying diseases, and cannot tolerate surgical thoracotomy at all. If a thoracotomy is forced, she will most likely not be able to step down. "

Lu Chen nodded solemnly, "Take me to see the patient's condition first."

…

came to the CCU bedside.

Gu Xinyue is checking the patient's condition beside the bed.

Seeing Lu Chen coming, he hurriedly stepped forward, "Director, you are here."

Lu Chen nodded, picked up the stethoscope, and began to examine the patient.

As Jin Miao said, the patient can hear wet rales all over the lungs.

"Bring me the ultrasound machine." Lu Chen said solemnly.

"Well, it's ready." Gu Xinyue quickly pushed the cardiac ultrasound machine over.

Lu Chen personally performed a cardiac ultrasound on the patient.

Bedside echocardiography tips: LV: 43mm, LA: 43mm, EF: 34.3%.

Left atrium enlargement, left ventricular lateral wall aneurysm formation, rupture and prolapse of the anterior mitral leaflet chordae tendineae and severe regurgitation.

The results of Lu Chen's examination were almost the same as those of the patient in the First Hospital of Modu.

"Director, after the patient's intervention in the First Hospital of the Magic City, the oxygen saturation of the patient's blood decreased gradually, the infection index increased, and a large dose of vasoactive drugs was needed to maintain blood pressure."

Gu Xinyue gave Lu Chen a more detailed report on his condition.

"After being transferred to our CCU this morning, he is currently undergoing ventilator-assisted ventilation, with anti-infection, anti-heart failure, blood pressure, phlegm-reducing, sedative and other treatments. Repeated chest X-rays show that pulmonary edema is gradually aggravating, and infection indicators continue to rise. High, the patient cannot be weaned successfully, the heart failure index shows an upward trend, and the heart function gradually declines.”

Lu Chen nodded, "We will have a difficult discussion within the Cardiology Department first, and then invite the Cardiac Surgery Department over."

"Okay, Director, I'll make arrangements immediately."

Afterwards, Jin Miao brought all the doctors with the title of deputy senior or above who were not currently on duty in the Cardiology Department.

Everyone gathered in the Cardiology Department Demonstration Classroom.

As long as the meeting is held here, everyone knows that there is a patient with a problem.

Gu Xinyue, as the doctor in charge, reported the medical history to everyone.

"Currently, we are mainly thinking about the reasons why patients cannot be taken offline? What are the next steps?"

Jin Miao was very enthusiastic and stood up first to speak.

"Consider the patient as an elderly woman with acute ST-segment elevation inferior myocardial infarction."

"Severe mechanical complications of mitral valve chordae tendineae rupture, leading to severe mitral valve regurgitation, acute heart failure, and severe pulmonary infection, renal insufficiency, hypertension and other complications, STS score 12.3%, surgical The risk of mitral valve repair is extremely high."

Lu Chen nodded slightly.

After so many years of training, Jinmiao has been able to fully analyze the patient's condition.

His statement is not much different from his own.

Next, several more doctors made brief speeches.

The main opinions of the doctors are the same, but there are some differences in the details.

In the end, in Lu Chen's concluding remarks, he concluded the coffin for the patient.

At present, the reason why the patient cannot be weaned is mainly due to mitral valve prolapse with severe regurgitation, which causes the patient to have recurrent heart failure.

And severe pulmonary infection caused by pulmonary congestion and long-term bed rest, the main crux is that the rupture of the chordae tendineae of the mitral valve leads to severe mitral valve regurgitation!

"Director, we have already consulted with surgery." Jin Miao continued, "Director of Cardiac Surgery feels that this patient's condition is critical and complicated, and he can't tolerate surgery, so he can't do thoracotomy at all."

The normal treatment method requires open chest to replace the mitral valve, so as to solve the severe mitral regurgitation.

But the current state of the patient does not allow surgery at all!

For a while, everyone in the classroom was silent.

It was because the patient could not tolerate surgery that he was transferred from the First Hospital of Magic Capital.

Lu Chen saw that everyone was silent, smiled and said slowly: "In May of this year, an article was published in EuropeaJournal, which talked about patients with acute myocardial infarction complicated by severe mitral regurgitation."

Seeing this, everyone looked at Lu Chen who was sitting in front.

After so many years, the whole cardiologist was full of admiration for Director Lu Chen.

Although Director Lu Chen is relatively young, he is one of the best in surgical operations in various fields of cardiology.

"Have any of you read this paper?" Lu Chen continued.

This time, no one spoke.

Lu Chen was not too surprised.

Everyone is usually very busy, and they can’t finish the work in their own departments, let alone read those scientific research papers.