Chapter 2376: Not a Good Sign
Some patients who experience transient arrhythmia may generally recover through their body’s self-adjustment, requiring no intervention.
On the other hand, electrical injuries might cause heart damage in a more insidious manner, making it difficult for doctors to detect. Some cases of delayed death are only understood after an autopsy reveals the problem.
You wonder, if the ECG shows no abnormalities and cardiac enzyme levels aren’t high, if doctors can’t diagnose a myocardial infarction, what treatment should they use?
Note, the ST segment elevation generally only indicates myocardial ischemia, not necessarily myocardial infarction.
Student Xie’s argument not only points to the patient having a myocardial infarction but also directly suggests a very severe heart muscle rupture.
How could a clinical attending physician easily believe a medical student’s ’wild ideas’?
Luo Jingming was pressured by the eyes of his superior. How could he respond? Cao Zhao should understand. Luo is from Guoxie, knows his junior apprentice better than Cao Zhao and others, and is certainly more inclined to believe Student Xie.
Beep beep, beep beep.
The ECG displayed on the child’s monitor was fluctuating, suggesting the child’s heart rhythm was leaning towards arrhythmia. The ventricular rate exceeded one hundred beats per minute. Children’s heart rates can be relatively high, but this child is more of an older child, so this rate is clearly abnormal. Moreover, the ECG showed premature beats, which is definitely not a good sign.
Cao Zhao reached out his hand.
Student Pan quickly handed over the ECG paper he was holding, having been prompted by Cao Zhao’s glance. Despite resembling a romantic lead from a TV drama, Cao Zhao, like Student Pan, is essentially a doctor and a true technical expert, never aspiring to be a movie star.
In fact, Student Pan’s previous report on the ECG characteristics was not wrong. The only issue was the rapid changes in pediatric conditions coupled with the inherent speed in changes of cardiac patients.
Luo Jingming was alert enough to call for the defibrillator to be brought over, ready for immediate resuscitation.
The patient’s current heart rhythm issue might be due to a rupture of the heart muscle.
During a previous surgery at Guo Zhi Hospital, the "head" muscle within the heart’s structure was discussed. It is the heart muscle connected to the chordae tendineae, with the ends attached to the valve. The connection can be likened to mechanical conduction, providing a continuous biological energy source for the valve’s opening and closing.
The Left Ventricle’s "head" muscle ultimately supports the heart’s most important valve, the mitral valve. If it encounters trouble, it will inevitably affect the valve’s function, leading to acute pulmonary edema and heart failure as clinical manifestations of mitral valve regurgitation.
Indeed, if the Left Ventricle’s heart muscle completely ruptures, one-third of patients may die immediately, and over half may not survive for twenty-four hours without surgical correction, making survival virtually impossible.
"You’re saying it’s a partial rupture?" Cao Zhao scanned the ECG paper while asking the student’s perspective again.
"Yes," Xie Wanying replied, "as you know, the Left Ventricle’s heart muscle divides into two groups. Anatomically, the anterior group integrates into one muscle piece, so if it ruptures, it is a complete rupture, making sudden death likely. The posterior group is not like this; it’s composite, so ruptures tend to be partial rather than complete. The anterior group’s corresponding ECG changes are on the anterior wall, while the posterior group’s are on the lower wall."
This perfectly corresponds with Student Pan’s report on the ECG’s indication of lower wall myocardial ischemia.