"What? My heart is not good?" Zheng Ren asked.

"The left ventricular hypertrophy is already heart failure," Su Yun said. "If this is in the United States, I will definitely join the list waiting for a heart transplant and start queuing up for donors."

"Echocardiac dysfunction should also be combined with an electrocardiogram to determine left ventricular hypertrophy, otherwise the error will be relatively large." Zheng Ren was still watching the movie, but he talked endlessly.

"There is a case report in New England that patients have significantly low limb conduction voltage, and the amplitude of the q wave is even lower than that of the p wave.

The electrocardiogram seems to be difficult to associate with left ventricular hypertrophy, but the echocardiography showed significant left ventricular hypertrophy. Finally, through magnetic resonance and biopsy testing, it was diagnosed as 'myocardial amyloidosis'."

"Boss, you are a general surgeon, why do you do so much research on our mind?" Su Yun did not refute, he also knew about this.

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

It doesn’t matter if you are thick-skinned in other subjects. If you really get your mind beaten by your boss, you will be too embarrassed.

Su Yun thought to himself.

"Is it different?" Zheng Ren said: "The contradiction between electrocardiogram and cardiac ultrasound diagnosis of left ventricular hypertrophy is that its mechanism is different.

The former reflects whether cardiomyocytes have hypertrophy through cardiomyocytes through electrophysiological reflex activities, while the latter is evaluated by subjective measurement of the ventricular wall.

Cardiac magnetic resonance is expensive, but its repeatability, sensitivity and tissue specificity are significantly better than the previous two, which helps to identify etiology. However, there are not many cardiac nuclear magnetic resonance units in the country."

"Do you think it's in Haicheng? Now the provincial capital-level cities have a heart MRI." Su Yun seized the flaws in Zheng Ren's words and began to despise him, "It's just that the price is a bit more expensive, ranging from 6,000-10,000."

"Oh, that's pretty good." Zheng Ren put down the film and started looking at the test form.

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

Su Yun said looking at the patient's electrocardiogram.

"It cannot be so arbitrary. Compared with sensitivity, its specificity is higher, and 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 missed diagnosis rate."

"When it comes to sensitivity, echocardiography is more sensitive to left ventricular hypertrophy than electrocardiogram. Left ventricular hypertrophy can be detected through the corrected left ventricular mass index. The most commonly used lvmi is to use lvm divided by body surface area, and use devereux correction formula... You know the devereux correction formula."

Zheng Ren looked at the test form and asked casually.

"Boss, I am the star of tomorrow in the cardiothoracic surgery. Who are you talking to?" Su Yun said disdainfully: "Devereux correction formula, I can mentally arithmetic."

"Brother Song, do the patient's family plan to prepare for treatment?" Zheng Ren suddenly asked.

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

Just now, Boss Zheng and Su Yun talked about professional terms for a long time, and Song Ying didn't understand any of the devereux correction formulas.

Not to mention him, even clinicians like Chang Yue are just listening to thunder.

But why did Boss Zheng ask the patient's family if he had plans to treat it?

"That's right, the liver is not a big problem, the main problem is still on the heart." Zheng Ren smiled and said, "If the heart problem is in the United States, I will be prepared for a heart transplant. But you also know our situation. There will not be many heart donors a year, and the elderly'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 something wrong with his speech logic. After all, Song Ying was not a medical person. Although he was talented and searched online, he could know some related situations.

But if the patient's situation is really told to him, he will talk about it little by little from the beginning.

"Then let's start from the beginning." Zheng Ren picked up the test form and said: "The medications include apixaban, bumetanib, diltiazem, aspirin, amiodarone and midojun hydrochloride. Except for shortness of breath, the patient's vital signs are within the normal range."

"I looked at the medical record and said that the old man had arrhythmia for 30 years and had been taking amiodarone for treatment."

Song Ying nodded. Before he came, he also had some understanding of the old man’s medical records.

After all, it is always not good to come to Boss Zheng to watch a movie when he comes to the door and says he doesn’t understand anything he says. It is necessary to leave a good impression on Boss Zheng.

"Hepatic dysfunction, alanine aminotransferase 176u/l, aspartate aminotransferase 236u/l, alkaline phosphatase 104u/l, bilirubin 1.5mg/dl, albumin 2.6g/dl. I guess the local doctor mobilized the patients to do a plain liver CT scan because of this, and the problem was found."

"Although there is no intravenous imaging, which is what we often call enhanced images, the abdominal CT scan shows that the liver is very bright, like a light bulb. The abdominal CT scan shows the liver density gt; 100hounsfield unit, considering the deposition of a large amount of radioactive dense substances in the liver parenchyma of the elderly."

"..." Song Ying was a little surprised to see that Zheng Ren was not shiny liver.

"These substances are actually just deposition after drug metabolism, and they are nothing." Zheng Ren said calmly: "Amiodarone belongs to the third category of antiarrhythmic drugs. It has mild non-competitive A and β adrenaline receptor blockers. It has mild antiarrhythmic drugs and has mild category 1 and 4 antiarrhythmic drugs."

"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 enhancement of CT would brighten the organs needed to provide the doctor with more information.

"At the molecular level, amiodarone contains 2 iodine atoms, accounting for 40% of its molecular weight.

In addition, amiodarone deposits in the body for a long time because of its long half-life. According to research, its half-life is between 2 and 4 months. Since the pH gradient allows amiodarone to form a hydrophobic bond with polar lipids, the amiodarone molecule is captured in the lysosome.

In this way, amiodarone can escape the breakdown of phospholipases and stay in the cells for longer periods of time."

Zheng Ren explained little by little.

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

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