Chapter 1865： Just stop taking the medicine

"How? Heart is not good?" Zheng Ren asked.

"Left ventricular hypertrophy, already heart failure." Su Yundao, "If this is in the United States, it must be added to the list waiting for heart transplant, and began to queue up for donors."

"Echocardiographic judgment of left ventricular hypertrophy should be combined with electrocardiogram, or the error is relatively large." Zheng Ren is still watching the film, but his mouth is endless.

"There was a case report in New England where the patient had significant limb-guided low voltage and the qrs wave amplitude was even lower than the p-wave.

Electrocardiograms appear to be difficult to associate with left ventricular hypertrophy, but echocardiography shows significant left ventricular hypertrophy. Finally, myocardial amyloidosis was diagnosed by magnetic resonance and biopsy. ”

"Boss, you a doctor of general surgery, do so much research on our minds." Su Yun did not refute, he also knows this.

It seems that after talking to the boss, you have to be careful. If you catch a flaw, you will say that you are speechless.

Other disciplines have a thick face and it doesn't matter. If you are stunned by your boss, you have no face.

Su Yun thought of it.

"Not the same." Zheng Rendao: "The contradiction between electrocardiogram and echocardiography in the diagnosis of left ventricular hypertrophy is that the mechanism is different.

The former reflects the presence of hypertrophy in cardiomyocytes through cardiac electrophysiological reflex activity, which is assessed by subjective measurements of the ventricular wall.

Cardiac magnetic resonance is expensive, but reproducibility, sensitivity, and tissue specificity are significantly better than the first two, contributing to the identification of etiology. But the heart of nuclear magnetic, there are not many in the country. ”

"Do you think it is in Haicheng? Now the provincial capital city has a nuclear magnetic core." Su Yun grabbed the flaws in Zheng Ren's words and began to despise him. "It is expensive, ranging from 6000-10000."

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

"Electrocardiogram diagnosis of left ventricular hypertrophy is really good. The examination is simple and easy. Many domestic and international hypertension guidelines recommend ECG as a means of detecting left ventricular hypertrophy, but the sensitivity is low, for mild and moderate/severe left ventricular hypertrophy. The sensitivity is 7% to 35% and 30% to 60%, respectively."

Su Yun looked at the patient's electrocardiogram.

"It can't be so arbitrary. Compared with sensitivity, its specificity is higher. The specificity of diagnosis 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, echocardiographic diagnosis of left ventricular hypertrophy is more sensitive than ECG, and left ventricular hypertrophy can be detected by corrected left ventricular mass index. The most commonly used lvmi is lvm divided by body surface area, corrected using devereux Formula...devereux correction formula you know."

Zheng Ren looked at the test list and asked casually.

"Boss, I am the star of the cardiothoracic surgery tomorrow, who are you talking to?" Su Yun said disdainfully: "devereux correction formula, I can mentally calculate."

"Song Ge, is the family of the patient planning to heal?" Zheng Ren suddenly asked.

"Yes." Song Ying did not understand what Zheng Ren meant.

Just Zheng boss and Su Yun said that half a day of professional terminology, what devereux correction formula and so on is not understood.

Not to mention him, even Chang Yue, a clinician, is a duck listening to thunder.

Can Zheng boss ask the family members whether they have plans to heal?

"This is the case, the liver problem is not big, the main problem is still in the heart." Zheng Ren smiled and said: "The problem of the heart, if in the United States, directly prepare for heart transplant. But we also know the situation There will be no heart donors in a year, and the physical condition of the elderly is absolutely not so long."

Song Ying frowned, he did not understand what Zheng Ren said.

Zheng Ren thinks that the logic of speaking is a problem. After all, Song Ying is not a medical person. Although he has the talent to search the Internet, he can know some related situations.

But the situation of the immediate patient is really to talk to him, but also from a little bit.

"That's what we said from the beginning." Zheng Ren took the test sheet and said: "The medication includes apixaban, bumetanide, diltiazem, aspirin, amiodarone and midodrine. In addition to shortness of breath, the patient's life Signs are within the normal range."

"I see the medical record. It has been said that the elderly have had arrhythmia for 30 years and have been taking amiodarone for treatment."

Song Ying nodded. He did a little understanding of the medical records of the elderly before he came.

After all, looking for Zheng Boss to watch the film, saying that he does not understand, is not always good. It is necessary to leave a good impression on Zheng Bo.

"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 the local doctor is mobilizing the liver ct scan of the patient because of this, and the result is a problem."

"Although there is no intravenous angiography, which is what we often say to enhance the image. But the abdominal ct scan shows that the liver is very bright, like a light bulb. Abdominal ct scan shows liver density > 100 hounsfield units ~ www.novelhall.com ~ consider the elderly liver A large amount of radioactive dense material is deposited in the substance."

"..." Song Ying sees that Zheng Ren does not just take the bright liver, something is wrong.

"These substances are actually depositions after drug metabolism, which is nothing." Zheng Ren said calmly: "Amiodarone belongs to three types of antiarrhythmic drugs. It has mild non-competitive a and beta. Adrenergic receptor blockers with mild grade 1 and 4 antiarrhythmic properties."

"I will not talk about the specific drug mechanism. Simply put, as the name suggests, amiodarone contains iodine."

This sentence Song Ying counts to understand.

The contrast agent contains iodine, which is known to Song Ying, so the enhanced ct will brighten up the needed organs and provide the doctor with more information.

"At the molecular level, amiodarone contains two iodine atoms, accounting for 40% of its molecular weight.

In addition, amiodarone is deposited in the body for a long time due to its long half-life, which has been studied to have a half-life of between 2 and 4 months. Since the pH gradient allows the amiodarone to form a hydrophobic bond with the polar lipid, the amiodarone molecule is captured in the lysosome.

In this way, amiodarone can escape the decomposition of phospholipase and stay in the cell for a longer period of time. ”

Zheng Ren explained a little bit.

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

"Well, this is basically the case." Zheng Rendao: "This liver is caused by the long-term oral administration of amiodarone, which leads to the deposition of iodine."

"The problem is not big. It will gradually recover after stopping the drug. But the main problem is the heart."

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