Yuan Ping'an is a lord who does not believe in evil. Everyone said that Sun Lien's face was dark, as long as the patient he took over was not a rare disease, it had to be an atypical symptom. Although the correct cause can be found in the end, it is a bit tiring to encounter such a patient. Other doctors generally do not invite Sun Lien to a consultation unless they have to.

Yuan Ping'an, on the other hand, has a different view. He felt that it was a good thing that Sun Lien came to the consultation to check out the patient's rare disease.

Regardless of whether Sun Lien came for consultation or not, the disease itself does not change because of the doctor's diagnosis. The diagnosis of a rare disease at least clarifies the direction of treatment or control of the disease. This is of course a great thing for the patient - it is better than being misdiagnosed as a common disease and then the disease progresses further after repeated treatments.

"What's the problem?" Although Yuan Ping'an is still the attending doctor of the emergency department, he has completed the support task, and he has been the general manager for a year and has enough articles to back him up. Therefore, now in the emergency department, everyone basically regards Yuan Ping'an as a deputy high. If it weren't for a particularly troublesome patient, he would not have been called to a consultation. Because he understood this, Yuan Ping'an decided to simply call Sun Lien to go over and have a look.

"Male, twenty-five years old. Chest tightness after activity. "The one who came to call Yuan Ping'an was a young doctor. Sun Lien met him twice in the emergency department — probably as a new intern or a rotational trainee?" ”

"Huh?" Yuan Ping'an was a little surprised when he heard this, "Why haven't you seen a doctor all this time?"

It's not uncommon for patients to delay treatment for a variety of reasons. However, this kind of thing usually happens when "the test results indicate that there is a disease, but the patient does not feel it". It is relatively rare for such patients to have obvious discomfort themselves, but have not seen a doctor for a long time.

"I don't know......," the young doctor was a little embarrassed, "I wasn't there when I asked for my medical history, and it was Dr. Cao who asked me to invite you over." ”

What Dr. Cao is talking about must be Cao Yanhua. It stands to reason that patients with chest tightness after exercise are most likely to be the work of doctors in chest pain centers. However, Cao Yanhua will ask Yuan Ping'an to participate in the consultation...... It's a little weird.

Sun Lien, Yuan Ping'an and others quickly rushed to the rescue room, and saw Cao Yanhua frowning beside the bed.

"This patient...... I think I should probably go to your diagnostic center. Dr. Cao Yanhua first looked down at the test report and spoke, and then looked up and saw Sun Lien, "Yo, Team Leader Sun, are you here?"

"Brother Cao, can we be normal?" Sun Lien responded with a smile, "Or do you have to call yourself an official position in the future, and I have to change your name to Team Leader Cao?"

Cao Yanhua is the head of the rescue team of the Chest Pain Center of the Emergency Department of the Fourth Hospital. Although it is certainly not a big official, it is also a leadership position after all. That's why Sun Lien said this.

"Okay, good, normal. Cao Yanhua smiled and nodded, and then returned to normal. "This time the patient is not quite right, so I asked you to come and have a look. ”

When he said, "Something is wrong with the patient", Cao Yanhua took two steps to the side and used a relatively low volume. It can be seen that he does not want patients to hear his "evaluation" directly.

"What's the problem?" Yuan Ping'an began to ask, "This is a ...... Chest pain?"

"Herein lies the problem. Cao Yanhua nodded, "The patient has no previous history of hypertension and no family history of chest pain. The lipids have just been checked, and all of them are normal - but the cardiac ultrasound shows that the patient has varying degrees of regurgitation in the left and right atrium, mitral and tricuspid valves. Coronary CT and angiography have just been done, and the left main stenosis is 99%, trifurcation lesions, anterior descending artery stenosis is 99%, TIMI blood flow is grade 1, and circumflex artery stenosis is 99%, TIMI blood flow is also grade 1. ”

This condition is very serious. But...... It's not difficult to diagnose. Severe stenosis of the coronary arteries is basically a declaration that the patient needs a stent or bypass surgery. Judging from the three stenosis, either the patient himself is born with a right side circulation advantage, or there is a compensatory hyperplasia in the right coronary artery.

"It's all on the imaging, why didn't you get the stent off?" Yuan Ping'an and Sun Lien had the same question. Generally, after a coronary angiogram, the doctor will fit a coronary stent directly into the patient. This saves money and repeats it later, which is a relatively acceptable treatment plan for patients and doctors.

"Because it's not sure what causes the stenosis. Dr. Cao took out a blood lipid test, "The blood lipid level is normal. Patients at this level of 25 years generally do not develop coronary artery stenosis. ”

Coronary artery stenosis is most likely to occur in patients with excess blood lipid levels. This is one of the greatest consensus among doctors in their practice. The more unhealthy the patient, the more likely it is to develop this problem, which is the high level of blood lipids in the body, causing fat to agglutinate on the walls of coronary or other arteries at a much faster rate than normal. And once the accumulated fat begins to change into hardened plaques under the action of the immune system, it will start to cause changes in the hemodynamics of the blood vessels.

The blood vessels of the human body are like rivers. A stone at the bottom of the river that cannot be pushed by the river can cause the sediment to start to accumulate rapidly near the stone. And after the hardened plaque appears, there will inevitably be layers of fat attached to the plaque and will be attacked by the immune system again, thus becoming a new plaque.

When the plaque is thick enough to block most of the blood vessels, coronary artery stenosis appears. Narrowed coronary arteries can lead to insufficient blood supply to the heart muscle, resulting in a number of symptoms, including chest pain. In the most severe cases, it can cause ventricular fibrillation, atrial fibrillation, and even cardiac arrest.

And this is the reason why Dr. Cao Yanhua requested a consultation - this patient has normal blood lipid levels and blood sugar is also within the normal range. This is equivalent to a river channel with not much sediment, and suddenly there are three small islands of sediment.

Until the cause of the formation of the islands is understood, Dr. Cao Yanhua really did not dare to dredge the river channel by digging up the islands directly - if the existence of these three islands in the middle of the river means that the patient has a more serious underlying problem, it will inevitably lead to misdiagnosis.

"That's a thing......" Yuan Ping'an frowned, and he began to recall the reason why it was easy to induce hardened plaques. "The blood lipids are normal, have you checked the coagulation and immune antibodies?"

Coagulation abnormalities are also a major cause of coronary heart disease attacks. If the blood starts clotting on the blood vessels by mistake, then there is a real possibility of severe coronary artery stenosis. And immune antibodies are the other direction - vasculitis.

Vasculitis can occur in all blood vessels in the body. This variable cause of inflammation can eventually lead to breakage and inflammation of the lining of blood vessels. The destruction of the inner wall of the blood vessels will directly lead to abnormal blood flow, which can induce blood clotting or blood lipid deposition.