MTL - I Can See Health-Chapter 29 Break people's jobs!

   Chapter 29 Breaking people's jobs!

   Lu Chen's indifferent words made the two people in the office stunned.

   "This, isn't this room speed?"

  Lu Wenguo frowned into Sichuan characters.

   He walked to Lu Chen's side and looked at him on the electrocardiogram. He was in shock.

   The senior director of the Cardiology Department is very experienced. He has been engaged in clinical work for about 30 years and has rich experience.

   Many young people in the hospital were brought out by Lao Dong.

   Could it be that the electrocardiogram that Lao Dong couldn't see was seen by his son who had just graduated from medical school?

impossible!

   Absolutely impossible…

   Wu Yun didn't have so many ideas, and asked quickly: "Xiaochen, you said this is not room speed, what could it be?"

  Lu Chen flattened the electrocardiogram on the computer table, then looked up at Lu Wenguo and Wu Yun.

   "What do you see when you first look at this picture?"

  Reread this ECG.

   Wu Yun found that he could only see tachycardia, a tachycardia with a narrow QRS complex.

   "I, I'm not very good at reading electrocardiograms." Wu Yun touched the back of his head embarrassingly, "You can see a narrow QRS tachycardia."

   "Dad, what do you think?"

Lu Wenguo pondered: "The first is the left axis deviation, then the narrow QRS complex tachycardia, and the rSR' type in lead V1 and the blunt S wave at the end of leads V5 and V6, this should be the right bundle. branch block."

  Lu Chen smiled and gave Lu Wenguo a thumbs up.

   "Dad, you're quite good, and you've almost explained the contents of this electrocardiogram."

  Lu Wenguo frowned: "Xiaochen, if that's all, then Director Dong's diagnosis of Cardiology should be correct. This is supraventricular tachycardia with right bundle branch block."

   Wu Yun also looked at Lu Chen with the same doubts, isn't this the upper room speed?

  Why do you say it's not room speed?

  Lu Chen smiled and took out the compass, "Dad, I'll make a gesture on the picture and you'll know."

   "Look at the electrocardiogram, what is the relationship between the rhythms of the atria and ventricles?"

  Lu Wenguo looked towards the place where Lu Chen pointed.

   Atrial and ventricular rhythms seem to be unrelated.

   The beating of the normal heart is the beating of the atria caused by the sinoatrial node, which stimulates the beating of the ventricles.

   The rhythms of the atria and ventricles are regular and fixed.

   But in this picture, the beating of the atria and ventricles are completely separated!

   The atrium beats its own, the ventricle beats its own, the two have nothing to do with it!

   "This, is this compartmental separation?"

  Lu Wenguo grabbed the electrocardiogram on the table and watched without blinking.

   "Ah? Atrioventricular separation?" Wu Yun was stunned, "Isn't atrioventricular separation the most common ECG in VT, atrial fibrillation, and high-grade atrioventricular block? Then this picture..."

   "Well, Brother Yun is right!" Lu Chen nodded and smiled, "This is atrioventricular separation, and this picture is a very special type of ventricular tachycardia - left posterior branch ventricular tachycardia."

   "The left posterior fascicular ventricular tachycardia originates from the left posterior fascicular region, which is excited first, and then the left anterior and right bundle branch regions are excited later, which is equivalent to passive blocking by the latter two fascicles."

   "Therefore, the electrocardiogram showed right bundle branch block + left anterior fascicular block."

"Right bundle branch block is manifested in the rSR' type in lead V1 and the thick and blunt S wave at the end of leads V5 and V6, and left anterior fascicular block is manifested in left axis deviation. These two features constitute the left ventricle. The most striking feature of idiopathic ventricular tachycardia."

   "So, left posterior fascicular tachycardia is easily confused with paroxysmal supraventricular tachycardia with right bundle branch block."

  The barriers of various medical specialties are extremely deep, and there is little understanding between various medical specialties, let alone internal medicine and surgery.

  Lu Wenguo and Wu Yun had never heard of this "left posterior fascicular ventricular tachycardia".

  Although he didn't understand what Lu Chen was talking about, Lu Wenguo had an intuition that Lu Chen was probably right.

   Because in this electrocardiogram, he did find the phenomenon of atrioventricular separation.

"Xiaochen, ventricular tachycardia is a malignant arrhythmia. The average person's ventricular tachycardia lasts for such a long time, and people should have died a long time ago." Wu Yun wondered, "But our patient's state is stable, but he feels a little flustered and hemodynamic. It's all stable, it's not like ventricular tachycardia!"

  Lu Chen explained with a smile: "Because this left posterior fascicular ventricular tachycardia is a benign ventricular tachycardia, which is common in healthy men."

   Wu Yun was like a student full of curiosity at this time, "Then how should this kind of ventricular tachycardia be treated?"

  Lu Chen picked up the milk tea on the table and took a sip.

   "This left posterior fascicular tachycardia has another name, verapamil-sensitive ventricular tachycardia. As the name suggests, verapamil can stop the attack."

  Lu Wenguo and Wu Yun looked at each other, and both of them could see the surprise in their eyes.

  Lu Chen speaks righteously and makes sense, so he has to be convincing!

   Is this still a medical student who just graduated?

"Dad, don't look at me with such a strange look." Lu Chen shrugged his shoulders and said, "When I was an intern in the Cardiology Department of Jiangcheng Central Hospital, I encountered several cases of this type of patient, one of which was It was also regarded as supraventricular tachycardia, which was finally discovered because the radiofrequency ablation was unsuccessful."

  Wu Yun smiled aside, "Xiaochen, you can't just read an electrocardiogram once, you must have put in a lot of effort."

   At this time, Lu Wenguo almost believed Lu Chen's diagnosis.

   But to be on the safe side, he still called the old director of the Cardiology Department.

   Lao Dong was lying in the duty room and swiping Douyin. When he saw that it was Lu Wenguo's call, he sighed helplessly.

   "Hey, these surgeons are just too nervous, isn't it a supraventricular tachycardia? It's been a few phone calls."

   Lao Dong sat up, cleared his throat, and answered the phone.

   "Hey, Lao Lu, your patient hasn't been cardioverted yet?"

"not yet."

   "Ouch, Lao Lu, don't be too nervous. Many patients in our department have high ventricular speed for most of the day. When you use Dalong, your heart rate will slowly drop."

  Lu Wenguo held his mobile phone and recalled what Lu Chen said just now, "Old Dong, do you think this patient has SVT?"

   "Why, I saw the electrocardiogram." Lao Dong smiled, "Supraventricular tachycardia with right bundle branch block, that's right, I'm sure."

  Lu Wenguo paused and said slowly, "Old Dong, then I will make a separate diagnosis. Don't mind me."

   "It's okay, you said." Lao Dong thought it was a little funny, how could a surgeon analyze this kind of electrocardiogram?

   "Do you think there is a possibility of left posterior fascicular ventricular tachycardia in this electrocardiogram?"

   "Huh? What?" Lao Dong was taken aback for a moment, "Left posterior branch ventricular tachycardia?"

"yes."

   On both sides of the phone, it was suddenly quiet.

   It seems that only the other party's breathing can be heard.

  Lu Wenguo was waiting for Lao Dong's reply.

   Lao Dong's mind was recalling the ECG characteristics of "left posterior fascicular ventricular tachycardia".

   After a long while, the old Dong said: "Old Lu, you send the electrocardiogram to my WeChat, I will take a look, and I will reply to you later."

"it is good."

   hung up the phone, Wu Yun immediately stepped forward: "Director Lu, what did Director Dong say?"

   "Let me send him the picture again so he can take a look."

  Lu Wenguo soon sent the electrocardiogram to Lao Dong via WeChat.

  It took about two minutes.

  Lu Wenguo received a WeChat message from Lao Dong.

   "Damn it, Lao Lu, when did you learn to read an electrocardiogram?! You're going to ruin my job!"

   (end of this chapter)