In addition to viral myocarditis and fulminant myocarditis, viral infection of the heart can also cause infective endocarditis.
Li Jingsheng has now ruled out the possibility of myocarditis, because many symptoms are not consistent, so there is only the last possibility left. The patient has infective endocarditis.
First, the site of myocarditis is the myocardium, while the site of endocarditis is the endocardium, with the valves being the most commonly affected site.
When he auscultated the patient, he heard that rough and loud heart murmur. With his proficient cardiovascular diagnostic skills, he was sure that if it was only a slight degree of valve insufficiency, it would not cause such a loud noise.
This shows that the valve is not only incompletely closed, but may also be damaged by virus invasion.
From the perspective of symptoms, after the endocardium is infected by viruses or bacteria, the fever is usually not obvious in the early stage, and the fever will not start until the disease progresses. Or intermittent low fever.
The heat course is usually long and the heat pattern is irregular. It may also be accompanied by symptoms such as night sweats, loss of appetite, and joint pain.
Because the valves are damaged, a heart murmur is often heard and appears rough and loud.
This is also highly consistent with the patient's symptoms.
In addition, the progression of infective endocarditis is relatively mild and not as scary as fulminant myocarditis.
There are often prodromal signs before its onset.
This is also highly consistent with the patient's disease progression.
Li Jingsheng gradually clarified the cause of the patient's disease through repeated deductions.
"Under normal circumstances, diarrhea will not lead to infective endocarditis. This is because the heart has a relatively strong defense network. However, the patient's valve itself has incomplete closure, which gives the virus unlimited opportunities. Diarrhea is often caused by bacteria invading the human digestive tract, such as the most common E. coli, salmonella, etc.
The patient's chest pain began the day after diarrhea and gradually worsened thereafter.
This shows that the virus that causes diarrhea is likely to invade through the incomplete heart valve, eventually causing infective endocarditis. "
After layer upon layer of syndrome differentiation, Li Jingsheng finally understood the patient's pathogenesis and cause.
Now that the cause and pathogenesis have been clarified, there is still a more difficult task, which is to persuade the patient to go to a large hospital overnight for further examination and treatment.
After more than ten minutes, the programmer guy came out holding on to the wall.
Looking at this situation, I almost collapsed.
It seems that his diarrhea is quite serious.
"Dr. Li, I'm sorry to keep you waiting. Is there no serious problem with my heart? Can you prescribe some antidiarrheal medicine for me? I have to go to the company at six o'clock tomorrow morning because the boss requires that the project be completed by eight o'clock. .”
The patient's speech became weak.
Severe diarrhea is most likely to cause dehydration and electrolyte imbalance. Timely hydration is important.
Some people with diarrhea think that drinking water will aggravate diarrhea. In fact, there is no scientific basis for this. On the contrary, not replenishing water will lead to many adverse reactions after the body is dehydrated, which is extremely harmful.
Another point is that diarrhea is actually a self-protection mechanism of the body.
It excretes a large amount of viruses and necrotic tissue cells from the body through diarrhea, which is very beneficial to the body's recovery.
Just like in the days when a cold patient is about to recover, there will always be a lot of purulent nasal discharge.
That can also be understood as detoxification.
"Just now I carefully reviewed your condition, course, symptoms, and causes, and came to a very serious conclusion. First, I suspect that your heart valves have insufficiency. Second, I suspect that the bacteria that caused your diarrhea have already The infection has reached the lining of the heart, causing serious damage to the heart valves. Third, your disease is still progressing rapidly and may cause sudden cardiac death or cardiac arrest at any time.
To sum up, I strongly recommend that you immediately go to a large hospital for treatment overnight and just go to the emergency room.
This is my preliminary diagnosis result and suspected cause. They are all written down. After you go to the emergency room, if the doctor who treats you does not pay attention to it or asks you to wait in line for a long time, you can directly show this to the nurse or doctor. , they should open a green channel for you. "
Li Jingsheng has worked in a large hospital and knows the emergency mechanism very well.
Doctors who work the night shift may sometimes be interns.
Diagnosis in cardiovascular medicine is extremely difficult. If this guy is unlucky and encounters an unreliable doctor, they will check him casually and then say, "It's nothing serious. Just prescribe some medicine and go home to rest." Follow-up for any discomfort.”
This guy definitely trusts the diagnostic opinions of the doctors in the hospital more.
Plus eager to work.
At that time, nine times out of ten, he will go home to take medicine and rest, and the consequences will be disastrous.
Li Jingsheng wrote down all his diagnostic ideas. As long as the doctor who treated him didn't treat human life as trivial, it would definitely attract some attention.
At least they will conduct further examination on this buddy, and even consult the superior doctor on duty.
"Yes, is it that serious?"
The patient could not understand those professional terms, but from Li Jingsheng's serious expression and solemn tone, he could feel that the problem was serious.
"I can't say that my diagnosis is 100% correct. At least I strongly recommend that you do as I say. It's not far from the Second Hospital. You can just take a taxi there. I suggest that you don't walk there. , now you have to avoid overexertion in your case, otherwise it will increase the burden on the heart, and the condition may deteriorate rapidly. At that time, the difficulty of treatment will be greatly increased, the cost of treatment will be doubled many times, and the treatment time will be greatly extended."
Li Jingsheng replied seriously.
"Then... okay! I listen to you and take a taxi to the hospital now."
The patient was a little scared by what he said.
It’s about life and it’s impossible not to take it seriously.
"There must be no delay. The sooner you get to the hospital, the better. Also, if your family members are here, it's best to inform them to rush over. If you really don't have any family members here, you can just find a friend you trust."
If you want to have surgery, you will definitely need family members to sign and accompany you.
Although Li Jingsheng was relatively new to the extracardiac field, this patient's heart valves were insufficient and the sound was so loud that the possibility of surgery was extremely high.
"Ok, thank you!"
The patient nodded gratefully to Li Jingsheng and walked outside.
After going out, he quickly opened the glass door and poked his head in. "Doctor Li, can I go to work at six o'clock tomorrow morning?"
"Don't think about going to work now, it's important to save your life. Besides, after the examination at the big hospital, if there are no major problems, you can definitely go back to work. If there are problems, just ask for leave directly from the boss, and the boss will understand you. of."
It’s not easy for every striver.
This buddy is already so ill, and all he thinks about is whether the work can be completed in time.
"okay, bye!"
The patient really left this time. He hailed a taxi outside the door and got in.
Li Jingsheng breathed a sigh of relief when he saw this, with a smile on his face.
He was not upset about losing a business selling antidiarrheal medicine.
On the contrary, he was extremely pleased and sincerely hoped that this young man working alone in a big city would be safe.
What would the attending doctor in the big hospital think after seeing the diagnosis note written by Li Jingsheng?
First of all, there must be doubts. Can a doctor in a small clinic diagnose difficult diseases in cardiology?
Then when the results come out, if the patient is really diagnosed with infective endocarditis, the doctors at the hospital will probably be shocked.
