I Can See Health

"Junior sister Ke, what diagnosis are you considering?"

Sun Guoguo looked at Ke Yue standing aside.

"I, I judge from the electrocardiogram results that the patient is more likely to have coronary heart disease." Ke Yue frowned and whispered, "Of course, I do not rule out other chest pain diseases."

"Junior Brother Dong, what's your opinion?"

Dong Hao touched the back of his head and said, "I also think it is coronary heart disease. The electrocardiogram and symptoms are consistent with the diagnosis of coronary heart disease."

"Look, I've said it many times that I have coronary heart disease, and you still ask me so many times. It's a waste of time." Fu Fengqin raised her eyebrows and looked as if she had coronary heart disease and she was very proud.

"Junior sister Jiang, what do you think?"

Sun Guoguo looked at Jiang Qingyan with a smile again.

"Sister, although the patient's electrocardiogram shows myocardial ischemia, she does not have high risk factors for coronary heart disease, nor does she have typical symptoms of angina. It can only be said to be suspected coronary heart disease. Digestive tract diseases, cardiac neurosis, and intercostal nerves need to be ruled out. pain, costochondritis, etc.”

"Yes." Sun Guoguo nodded, "What about the next treatment plan and plan that you think is feasible?"

Jiang Qingyan said softly: "Do coronary angiography or coronary CTA to rule out coronary heart disease; if the result is negative, then do a gastroscopy to rule out digestive tract diseases. Other minor problems can be checked slowly."

As soon as Jiang Qingyan finished speaking, Fu Fengqin immediately continued:

"Why should I do cardiac CT? I want to do cardiac angiography directly, which is highly accurate and can be done in one step. If I want to do cardiac CT, I can do it directly at the county hospital. Why do I come to you here?"

Lu Chen frowned.

This aunt's character is too impatient.

When the doctor said one thing, she would say ten more.

"Okay, Auntie, I already know your request." Sun Guoguo smiled, "I will complete the preoperative examination today and tomorrow, and then I will perform angiography surgery on you as soon as possible."

"Well, that's good." Fu Fengqin's ugly face improved slightly, "It's better for Dr. Sun to be happy, I will follow your arrangement."

…

Sun Guoguo led everyone away and returned to the doctor's office.

"Lu Chen, I didn't ask you just now, what do you think the patient's diagnosis is?" Sun Guoguo smiled.

Among everyone present, except for Jiang Qingyan's diagnosis, everyone else's primary diagnosis is closer to "coronary heart disease".

Lu Chen said solemnly: "I think the patient's age has not yet reached the standard for diagnosis of coronary heart disease, and he does not have the typical chest pain symptoms of coronary heart disease. In addition, we have also ignored a very important point, that is, the patient has recently started menopause. "

"Menopause?" Ke Yue frowned, "What does this have to do with chest pain?"

Lu Chen smiled and said: "After menopause, the patient's endocrine system is imbalanced and may cause autonomic nervous system dysfunction. What we often call menopausal syndrome will eventually lead to cardiac neurosis and subsequent chest pain symptoms. However, this The chest pain symptoms are not related to exertion or activity. In addition, this patient’s mood is irritable, which may also be related to cardiac neurological dysfunction.”

When the others in the group heard Lu Chen's explanation, their eyes showed a look of sudden realization.

At this time, Sun Guoguo smiled and said: "Actually, everyone's analysis makes sense. Whether the patient has coronary heart disease, cardiac neurosis, or chest pain caused by other reasons, the diagnosis and treatment ideas are similar. , we must rule out coronary heart disease first!”

"In case the patient has coronary heart disease, if we fail to detect it, it will be a dereliction of duty on our part as doctors, and it will also be a potential threat to the patient." Sun Guoguo continued, "So when you encounter a patient with this kind of chest pain, if you don't fully To be sure, it is still recommended to complete coronary CT or angiography to rule out coronary heart disease.”

"Secondly, it involves the question of what kind of examination should be performed. Should the patient be advised to complete cardiac coronary angiography or CTA?"

"For example, the 11-bed patient who just came here, from a medical professional point of view, do you think he should undergo CTA or direct angiography?"

Sun Guoguo smiled at Dong Hao and said, "Junior Brother Dong, please tell me first."

"I think it's better to just do cardiac angiography. If the patient has vascular stenosis and needs treatment, he will have to do cardiac angiography again. It's a waste of money for two examinations and an extra sin." Dong Hao thought for a while and said .

Ke Yue also nodded in agreement.

"Junior Brother Lu, what do you think?"

Lu Chen said solemnly: "I think it is still necessary to distinguish the condition. If it is just to rule out coronary heart disease, coronary CTA may be better. It is economical, non-invasive, simple, and the diagnostic accuracy is more than 95%."

"At that time, if the patient had high-risk factors, had typical symptoms - chest tightness and chest pain after activity, and had typical ischemic changes on the electrocardiogram, it would still be recommended to undergo cardiac angiography directly."

"The patient who was newly admitted just now, I think it is unlikely that he has coronary heart disease. Even if he does have coronary heart disease, it is not at the level of stent placement, so I suggested that she undergo coronary CTA."

As soon as he finished speaking, Sun Guoguo shook his head slightly and sighed: "Junior Brother Lu's ideas are more idealistic. In clinical practice, most of the time, there is a one-size-fits-all treatment plan. No matter what kind of patient it is, As long as you have chest pain, you may be asked to undergo cardiac angiography, which may involve disputes, medical expenses, patient wishes, etc. "

Lu Chen nodded slightly, what Sun Guoguo said made sense.

In terms of cost alone, cardiac angiography far exceeds cardiac CTA.

For the sake of performance, many hospitals will exaggerate the effectiveness of cardiac imaging to varying degrees.

Its complications and side effects are often avoided.

In fact, for a considerable number of patients, a simple CTA can rule out the diagnosis and avoid irreversible damage to blood vessels.

Sun Guoguo continued: "This new patient just now strongly requested a cardiac angiography after being admitted to the hospital. We will explain all the treatment options to her, including the advantages and disadvantages of each method, and then let her choose on her own. The most important thing is The only thing is that she needs to sign and agree to undergo a cardiac angiography before arranging the surgery.”

"Okay." Lu Chen nodded.

Clinically, it’s walking on thin ice.

Only by signing more, communicating more, and leaving documentary records can you protect your rights and interests to the greatest extent.

At the same time, when a medical accident occurs, the patient can also request the sealing of medical records as soon as possible and obtain relevant medical record documents as litigation materials.

…

Although this patient is a relative of Wang Zihao, looking at her attitude, she may not be easy to mess with.

Lu Chen tried his best to do everything he could to perfection.

Write the two treatment plans in the disease communication and have Fu Fengqin sign it.

Choose cardiac angiography instead of coronary CTA.

…