novel for you Chapter 1029: Two-pronged Advancement (Part )
Chapter 1029: Two-pronged Advancement (Part )
Chen Yang's drinking capacity is now the only shortcoming that everyone can make fun of.
"Everyone is pretty much familiar with the patient's condition..."
After Chen Yang finished speaking, he asked Zeng Yunhui, "Is the patient settled?"
"Director Chen, everything has been settled." Zeng Yunhui hurriedly stood up and answered. Did Chen Yang hear his complaints?
"Now let me talk about the division of labor."
Chen Yang said, "The Traditional Chinese Medicine Department is responsible for the patient's preoperative conditioning, and the cardiothoracic surgery team will formulate the surgical plan. I will not participate in the preoperative conditioning this time, I will only be responsible for reviewing it."
For Zhang Tiezhu's treatment this time, Chen Yang plans to adopt a two-pronged approach, which means that Chen Yang himself will not participate in the specific treatment of traditional Chinese medicine, but will hand it over to Xun Jiahong, Wen Manlu, Lin Yi and others.
With the development of Kyoto International Medical Center, Lin Yi, Xun Jiahong and others will inevitably have to take charge.
"The traditional Chinese medicine team is led by Xun Jiahong and Lin Yi, with assistance from others," said Chen Yang.
At present, in the traditional Chinese medicine team, Xun Jiahong, Lin Yi and Wen Manlu have the highest level. Wen Haodong is still in charge of David, Wen Manlu is in charge of Linlin, Li Chengjie is in charge of Ye Guoliang, and this time Zhang Tiezhu will be under the charge of Xun Jiahong and Lin Yi.
Of course, everyone will participate in consultations and discussions when they are not busy.
"Let's go see the patient first, and then come back to continue this discussion."
As he spoke, Chen Yang walked out of the consultation room and headed towards the ward.
58-year-old Zhang Tiezhu lay in his hospital bed, each breath accompanied by a heavy wheeze, like the strain of an old bellows. His face was gray, his lips an unhealthy shade of purple, and fine beads of sweat covered his forehead.
The door of the ward was pushed open, and Chen Yang and He Yonghua walked in side by side, followed by Lin Yi, Xun Jiahong and others.
"How do you feel?" Chen Yang walked to the bedside, his voice gentle but with a convincing calmness.
Zhang Tiezhu gasped for breath and managed a forced smile: "Dr. Chen... Doctor Chen... Director He... I'm gasping... I'm gasping so hard... I can't lie flat..."
That short sentence seemed to have exhausted all his strength.
Chen Yang nodded and made some room. Xun Jiahong stepped forward and did not rush to take Zhang Tiezhu's pulse. Instead, he carefully observed Zhang Tiezhu's overall condition.
The patient's chest was rising and falling violently but inefficiently, his jugular veins were distended, and there was mild pitting edema in both lower limbs. Xun Jiahong reached out and gently pressed Zhang Tiezhu's ankle, and the finger marks were clearly visible.
"Orthopnea, lower limb edema, cyanosis of lips and nails, distended neck veins..."
He Yonghua also observed and whispered to Qiu Yunshan, "Typical signs of severe heart failure, with obvious congestion in both the pulmonary and systemic circulations."
"The EF value is only 35%. The left heart's pumping function is severely impaired, and pulmonary congestion is inevitable."
Qiu Yunshan nodded and said, "The key is still the valve problem and that huge calcified ring."
While the two were talking, Xun Jiahong pulled the patient's arm, stretched out three fingers, and placed them on Zhang Tiezhu's strong but weak-pulse wrist.
The pulse feels heavy, thin, weak, and stagnant under the fingers, with occasional pauses (intermittent pulse). The tongue is enlarged, dark purple with teeth marks on the edges, and has a thick, greasy white coating. The veins under the tongue are tortuous and dilated, and the color is dark purple.
After the examination, the group returned to the consultation room again.
"First, bring up the patient's latest transesophageal ultrasound (TEE) dynamic image." Chen Yang ordered.
Soon, a clear dynamic image of the heart appeared on the huge display screen.
The heart that should have been beating strongly now looked tired and twisted, with the left ventricle significantly enlarged and unable to contract.
The most striking finding was the mitral valve annulus, which should have been flexible and open and closed. Instead, it was occupied by a dense, irregular, hyperechoic plaque of calcification, resembling a hard ring of bone. The calcification not only completely rigidified the annulus, but also prevented the leaflets from closing, leading to massive blood regurgitation.
A clear and obvious colorful mosaic regurgitant jet was clearly visible on the screen, which was deeply embedded in the myocardium of the posterior wall of the left ventricle and formed a huge bulge in the front, severely squeezing the space of the left ventricular outflow tract and making it extremely narrow.
"See? Here, the calcification has merged with the myocardium. Forced dissection is extremely risky and could easily damage the circumflex coronary artery and the conduction bundle."
He Yonghua pointed to a key spot on the screen, his brow furrowed. "And this convexity, like a huge rock blocking the water outlet. Once a standard-sized prosthetic valve is inserted, LVOT obstruction is almost inevitable, and cardiac output will not increase at all after the procedure."
The consultation room was silent, with only the faint beating of the heart in the ultrasound image and Zhang Tiezhu's heavy breathing coming from the ward.
The doctors at Haizhou Provincial Hospital all had solemn expressions and a hint of awe on their faces, and the members of He Yonghua's team in Kyoto also felt tremendous pressure.
"Director Chen, what do you think?" He Yonghua asked Chen Yang.
Hearing He Yonghua's question, Qiu Yunshan, who was listening, was subconsciously stunned for a moment.
How come Director Chen is also involved in the field of cardiothoracic surgery?
After Qiu Yunshan came to Kyoto International Medical Center, he respected Chen Yang because he knew that Chen Yang was actually the actual person in charge of Kyoto International Medical Center.
At the same time, Chen Yang's achievements in hepatobiliary surgery and traditional Chinese medicine are also worthy of Qiu Yunshan's respect.
But the field of cardiothoracic surgery is a new field after all.
But at this moment, He Yonghua was actually asking Chen Yang.
this.......
"Let's listen to the Chinese medicine treatment plan first."
Chen Yang said this and looked at Xun Jiahong and others.
"The four diagnostic methods of traditional Chinese medicine are: sitting upright, breathing, panting with movement, inability to lie flat, coughing up small amounts of white foamy sputum, palpitations, chills, cold limbs (especially in the lower extremities), pitting edema in both lower extremities, which is submerged when pressed, cyanosis of the lips and nails, and dilated neck pulses. Tongue: enlarged, dark purple with teeth marks on the edges, thick, greasy white coating. Pulse: deep, thready, weak, and stagnant, with intermittent pulses."
Xun Jiahong first recounted his previous examination and said, "Judging from the pulse and symptoms, this is a serious case of heart and kidney yang deficiency, water retention in the heart, and blood stasis blocking the collaterals!"
"When heart yang is deficient and its pulse is weak, palpitations and restlessness occur, and the pulse is deep, thready, weak, and intermittent. When kidney yang is deficient and qi transformation is impaired, water and dampness overflow, rising to the heart and lungs and causing wheezing, coughing, inability to lie flat, and phlegm and fluid. When it overflows into the skin, it causes edema..."
"Yang deficiency cannot warm the extremities, resulting in aversion to cold and cold limbs. Heart yang is weak, blood circulation is stagnant, and dampness blocks the flow of qi, aggravating blood stasis. This results in cyanosis of the lips and nails, a dark purple tongue, and tortuous and distended sublingual veins. A thick, greasy white coating on the tongue is further evidence of internal dampness."
Lin Yi also added.
"In terms of treatment, I think it should be used to warm the heart and kidneys, transform qi and promote water circulation, and activate blood circulation and unblock the meridians."
Lin Yi looked at Xun Jiahong and asked, "What do you think, Director Xun?"
"The patient is essentially deficient in heart failure and superficially deficient in Yang Qi, while the excess is fluid retention and blood stasis. The most urgent task is to warm Yang Qi and promote diuresis, relieve heart failure symptoms, improve cardiopulmonary function, and create conditions for surgery."
Xun Jiahong pondered for a moment and said, "I think we can use Zhenwu Decoction combined with Tingli Dazaoshaifei Decoction with some modifications."
"Pao Fu Zi 15g (pre-boil for 1 hour to remove toxins) - Very pungent and hot, warms the kidneys and supports yang, transforms qi and promotes water circulation, and is the main herb."
Poria 30g, Atractylodes macrocephala 15g, White Peony Root 15g – Based on the principles of Zhenwu Decoction, they strengthen the spleen and eliminate dampness, soften the liver and relieve urgency, and control the dry and harsh nature of Aconite. Ginger 15g – warms and disperses water vapor. Tripterygium wilfordii 15g (wrapped and decocted) – purges the lungs and relieves asthma, promotes diuresis and reduces swelling. It is used as an adjuvant for asthma and cough caused by water retention that makes it impossible to lie flat.
"Red ginseng 10g (stewed separately and taken with water) – greatly replenishes vital energy, restores pulse and strengthens heart yang. Salvia miltiorrhiza 30g, red peony root 15g, Chuanxiong 10g – activates blood circulation, removes blood stasis, dredges meridians, improves microcirculation, and reduces cardiac load. Cinnamon twig 10g – warms and promotes heart yang, supports the power of aconite, and can calm and reduce adverse reactions. Alisma orientalis 15g, Plantago seed 15g (decoction) – enhances diuresis and swelling-reducing effects..."