Chapter 1864 Just Stop Taking the Medicine

"What? Is your mental skill bad?" Zheng Ren asked.

"The left ventricle is hypertrophic and already has heart failure." Su Yun said, "If this is in the United States, it will definitely be added to the waiting list for heart transplantation and start queuing up for a donor."

"Echocardiography needs to be combined with electrocardiogram to judge left ventricular hypertrophy, otherwise the error will be relatively large." Zheng Ren was still watching the film, but he talked incessantly.

"There is a case report in New England, the patient has obvious limb lead low voltage, and the QRS wave amplitude is even lower than the P wave.

Electrocardiography seemed difficult to correlate with left ventricular hypertrophy, but echocardiography showed significant left ventricular hypertrophy. Finally, it was diagnosed as 'cardiac amyloidosis' by MRI and biopsy. "

"Boss, you are a general surgery doctor, why do you study so much on us." Su Yun didn't refute, and he knew about it.

It seems that you have to be careful when talking to the boss in the future, otherwise you will catch a flaw and you will be speechless.

It doesn't matter if other subjects have thick skins. It would be embarrassing if the boss pissed her off.

Su Yun thought in his heart.

"Is it different?" Zheng Ren said: "The contradiction between electrocardiogram and echocardiography in diagnosing left ventricular hypertrophy lies in their different mechanisms.

The former reflects the presence or absence of cardiomyocyte hypertrophy through cardiac electrophysiological reflex activity, while the latter is assessed through subjective measurements of the ventricular wall.

Cardiac magnetic resonance is expensive, but its reproducibility, sensitivity, and tissue specificity are significantly better than the former two, which is helpful for etiological identification. However, there are not many heart MRIs in the country. "

"You thought it was in Haicheng? Now provincial capitals have heart MRI." Su Yun grasped the flaw in Zheng Ren's words and began to despise him, "It's just that the price is a bit more expensive, ranging from 6000-10000."

"Oh, that's pretty good." Zheng Ren put down the film and started to look at the test sheet.

"The electrocardiogram is really good for diagnosing left ventricular hypertrophy. The examination is simple and easy to do. Many domestic and foreign hypertension guidelines recommend electrocardiography as a detection method for left ventricular hypertrophy, but the sensitivity is low. For mild and moderate/severe left ventricular hypertrophy The sensitivities were 7%-35% and 30%-60%, respectively."

Su Yun looked at the patient's electrocardiogram and said.

"It can't be so arbitrary. Compared with sensitivity, its specificity is higher. The specificity of severe left ventricular hypertrophy is as high as 80% to 90%. Obesity may affect the diagnosis of left ventricular hypertrophy by electrocardiogram, resulting in an increase in the rate of missed diagnosis."

"Speaking of sensitivity, echocardiography is more sensitive than ECG for the diagnosis of left ventricular hypertrophy, which can be detected by corrected left ventricular mass index. The most commonly used LVMI is LVM divided by body surface area, using Devereux correction The formula... you know the Devereux correction formula."

Zheng Ren looked at the test sheet and asked casually.

"Boss, I am a rising star in cardiothoracic surgery. Who are you talking to?" Su Yun said disdainfully: "Devereux correction formula, I can do mental arithmetic."

"Brother Song, do the family members of the patient have any plans for medical treatment?" Zheng Ren asked suddenly.

"Yes." Song Ying didn't understand what Zheng Ren meant.

Boss Zheng and Su Yun just talked about technical terms for a long time, and Song Ying didn't understand anything about the Devereux correction formula.

Not to mention him, even a clinician like Chang Yue is a duck to Tinglei.

But why did Boss Zheng ask the family members of the patients if they had any plans for treatment?

"It's like this. The liver problem is not that big. The main problem is the heart." Zheng Ren smiled and said, "If the heart problem was in the United States, we would directly prepare for a heart transplant. But you know our situation , there will not be a few heart donors a year, and the old man's physical condition will definitely not last that long."

Song Ying frowned, he didn't understand what Zheng Ren said.

Zheng Ren thought about it, and felt that there was a problem with the logic of his words. After all, Song Ying is not a person with a medical background, although with his talent, he can find some relevant information by searching the Internet.

But if you really want to tell him the situation of the patient in front of you, you have to start from the beginning.

"Then let's start from the beginning." Zheng Ren picked up the test sheet and said, "The medications include apixaban, bumetanide, diltiazem, aspirin, amiodarone, and midodrine hydrochloride. Except for shortness of breath, the patient's life The physical signs were all within the normal range."

"I looked at the medical records, and it said that the elderly had arrhythmia for 30 years and had been taking amiodarone for treatment."

Song Ying nodded. Before he came, he also did some research on the old man's medical records.

After all, it's always not good to come to Boss Zheng to watch a movie and say that I don't understand anything. It is necessary to leave a good impression on Boss Zheng.

"Abnormal liver function, alanine aminotransferase 176U/L, aspartate aminotransferase 236U/L, alkaline phosphatase 104U/L, bilirubin 1.5mg/dL, albumin 2.6g/dL. I It is estimated that because of this, the local doctors mobilized the patient to do a liver CT scan, and the problem was discovered."

"Although there is no intravenous contrast, which is what we often call enhanced images. But abdominal CT scans show that the liver is very bright, like a light bulb. Abdominal CT plain scans show liver density > 100 Hounsfield units, considering the large amount of radioactivity in the liver parenchyma of the elderly Dense material deposits."

"..." Seeing that Zheng Ren didn't care about his shiny liver, Song Ying was a little taken aback.

"These substances are actually just the deposition after drug metabolism. It's not a big deal." Zheng Ren said calmly: "Amiodarone belongs to Class III antiarrhythmic drugs. It has mild non-competitive α and β Adrenoceptor blockers. And mild class I and IV antiarrhythmic drug properties."

"I won't talk about the specific mechanism of the drug. Simply put, as the name suggests, amiodarone contains iodine."

Song Ying understood this sentence.

Song Ying knew that the contrast agent contained iodine, so the enhanced CT would brighten the needed organs and provide more information to the doctor.

"At the molecular level, amiodarone contains 2 iodine atoms, which make up 40% of its molecular weight.

In addition, the long-term deposition of amiodarone in the body is due to its long half-life. According to research, its half-life is between 2 and 4 months. Amiodarone molecules are trapped in lysosomes because the pH gradient allows amiodarone to form hydrophobic bonds with polar lipids.

In this way, amiodarone can escape the breakdown of phospholipase and stay in the cell for a longer time. "

Zheng Ren explained little by little.

"It is said that the drug concentration in the blood can be measured after stopping the drug for half a year." Su Yun added.

"Well, that's basically it." Zheng Ren said: "This liver is caused by the deposition of iodine element due to long-term oral administration of amiodarone."

"It's not a big problem. It will gradually recover after stopping the drug. But the main problem lies in the heart."