Around 10 am, a middle-aged man walked into the doctor’s office panting heavily. The eldest brother calls himself Jin, 49 years old this year, a freelancer and his own boss.
Brother Jin said that he has been experiencing chest tightness, shortness of breath, and difficulty breathing for two weeks. If he walks a few steps or climbs stairs, he even feels short of breath and his physical strength is severe. decline.
The doctor asked Brother Jin, “Do you feel more breathless or have difficulty breathing”? Brother Jin replied: “Half and half, just the two steps I just walked, almost didn’t exhaust me to death.”
This doctor basically has a judgment in mind, that is, Brother Jin’s cardiopulmonary function is a bit poor.
To be on the safe side, the doctor decided to first check his heart and lungs with a stethoscope. When hearing the lungs, there are obvious moist rales, which represents the possibility of pulmonary hydrops, and then the third and fourth heart sounds appear in the cardiac arrest response, which proves that the state of the heart is not very good.
The doctor then asked: “What do you like to do? Do you have a history of chronic diseases?”
Brother Jin replied: “I usually like to play football and read books. What is the history of chronic diseases? Does high blood pressure count?”
The doctor thought for a moment: “Good guy, another patient who doesn’t pay attention to high blood pressure”. This month, I have met three or four patients who do not pay attention to high blood pressure. One is a patient with cerebral hemorrhage and infarction, which is caused by not controlling high blood pressure in time.
Out of caution, the doctor measured Brother Jin’s blood pressure, and the results showed that both blood pressures were 185mmhg and above 99mmhg, which was a bit surprising and gave the doctor more information.
So he continued to ask him: “Why don’t you control high blood pressure? Why don’t you take medicine”? Brother Jin looked confused: “Why do I need to take medicine? I have high blood pressure for four years, and I have no symptoms at all. I play football every day, what are I afraid of?”
It was really reasonable and unclear when I encountered such a patient, so I told him: “Now I suspect that you have a problem with your heart and lungs, so let’s do an electrocardiogram and lung CT first.”
Brother Jin didn’t hesitate, turned around and took the form to check.
50 minutes later, Brother Jin sat in front of the doctor again. The doctor read his lung CT and electrocardiogram with a nervous expression. But obviously Big Brother Jin didn’t realize the seriousness of the problem, and he smiled and looked relaxed.
It turned out that Brother Jin’s lung CT showed severe pulmonary edema and pleural effusion. What’s worse was that his right heart had heart failure, so Brother Jin had severe pulmonary edema and pleural effusion. The problem is pulmonary circulatory failure. Without looking, you can tell that he must have the problem of edema of both lower extremities. Sure enough, after letting him lift his trouser legs, two swollen feet came into view.
At this time, there is no need to press any more. The doctor wrote the diagnosis result on the medical record, and then said to Brother Jin: “Get ready and be hospitalized immediately. Heart failure combined with pulmonary circulatory failure should be treated as soon as possible.”
Who knew that Brother Jin suddenly said: “I’m afraid I can’t be hospitalized today, I have to go back and explain my work, in a few days”.
The doctor was stunned. It was the first time that a patient with a serious illness negotiated with the doctor. This made the doctor unable to speak, so he had to say, “I heard it right, you Do you know how severe heart and lung failure is? Sudden death.”
Brother Jin smiled and said, “Don’t be afraid, I still have to go back and explain my work, otherwise they won’t handle it well.”
The doctor decided to struggle again: “Don’t go back, just make a phone call, with your current physical state, it is very likely that you will faint on your way home. , then it will really be troublesome!”
Brother Jin still smiled and said, “I’ll go back for a few days, and I’ll be hospitalized as soon as I make arrangements.”
In this regard, the doctor has nothing to say. After all, the patient’s decision has priority, so the doctor can only write “the patient refuses to be hospitalized” on the medical record, and then I handed the case to Brother Jin, gave him some emergency medicine, and saw him leave with a smile.
On that day, the doctor was in a very bad mood, just like the dark, dark and rainy feeling during the Qingming period.
In fact, Brother Jin’s heart and lung failure is relatively terminal, because he is pulmonary circulatory failure caused by systemic heart failure. heart disease, blood pressureHeart disease in the early stage is mainly due to changes in the structure and function of the left heart, resulting in hypertrophy, and then the heart’s ability to relax and pump blood is reduced.
Once the left heart failure begins, the patient will develop total heart failure within a short period of time, with symptoms such as exertional dyspnea, supine shortness of breath, and paroxysmal nocturnal dyspnea. Over time, bilateral lower extremity edema, liver and abdomen edema, pulmonary edema, pleural effusion, etc. will gradually appear.
If there is no intervention at this time, the patient may end up with sudden cardiac arrest due to excessive cardiac pressure, or accidental death due to cerebral infarction and pulmonary infarction. Only when the eldest brother is in the specific situation will he be so nervous, because he really can’t delay for a second or a minute now.
About his treatment, we generally start from these angles:
First, the primary disease must be controlled, such as gold The primary disease of the elder brother is high blood pressure. The blood pressure reaches 185mmhg/99mmhg. The doctor thinks it is a bit miraculous that such severe high blood pressure has no symptoms. Doctors first give antihypertensive drugs, usually drugs that dilate peripheral blood vessels, because they can reduce the pressure on the heart at the same time.
Secondly, it is necessary to solve the problem of water in the lungs, because Brother Jin has obvious symptoms of dyspnea and asthma, so the respiratory function of the lungs has deteriorated. If the problem of water accumulation is not solved in time, acidosis may occur. The problem of respiratory failure will cause many difficulties to rescue and treatment.
Third, if the patient’s heart failure has reached an advanced stage, it should be treated with diuretics, inotropes, and ACEI/ARB drugs.
However, these must be based on the cooperation of the patients. Now that many days have passed, I don’t know what happened to Brother Jin’s account, or that an accident has occurred. , It’s true that the emperor is not in a hurry and the eunuch is in a hurry.
Doctors believe that everyone should have a basic awareness of diseases now. Some things cannot be paid attention to by doctors alone, such as high blood pressure and diabetes. We all know that these diseases are very dangerous, and the treatment in the later stage is very difficult, but some patients do not pay attention to these diseases, feel that these diseases are paediatrics, they are unwilling to take medicine and do not cooperate with treatment, and the final consequences will be borne by themselves.