Diseases in older people are often atypical.
Older, sluggish, some uncomfortable feelings, or less accurate; older, generally have several chronic diseases, the symptoms of various diseases are intertwined, sometimes easily confused.
Therefore, to see the elderly, the doctor must be sensitive.
This case, of course, is a case of doctor misdiagnosis and missed diagnosis, and I put it here to remind me.
75-year-old grandfather, high blood pressure, had cerebral infarction, coronary heart disease or something not so precise, in short, there is a history of cardiovascular disease, is a high-risk group of coronary heart disease.
Not long ago, the old man felt uncomfortable all over his body, some low-grade fever, cough twice, fatigue, and went to the hospital to see a doctor. The doctor saw it and thought it was a respiratory infection, so he asked the uncle to go to the community for infusion and anti-infection. A careless, did not do an electrocardiogram.
However, after a few days of infusion, the condition did not improve, and added chest tightness and shortness of breath, and there was still a little wheezing. This is like a more "sitting" of the diagnosis of tracheitis and lung infection, continue to fight infection!
About 10 days or so, the old man's asthma became more and more aggravated, and on this day he suddenly had a violent asthma attack and went to the hospital emergency department.
Emergency doctor checks the electrocardiogram, is not good, large area of myocardial infarction? Hurry up and enter the ICU (Intensive Care Unit).
This is an electrocardiogram of the patient's emergency department.
This is a normal ELECTROCARDI.
Entering the hospital, myocardial enzymes, troponin, these myocardial damage markers are significantly elevated! Later, the heart ultrasound was checked, and the site of myocardial infarction had formed a wall tumor of the ventricle, and the ejection fraction of the heart was only 45%, and the cardiac function was reduced.
These confirm the diagnosis of acute myocardial infarction.
Although the symptoms of chest pain are not typical, the ECG has typical myocardial infarction changes, and the markers of myocardial damage such as myocardial enzymes and troponin are significantly elevated, which meets the diagnostic criteria. Not only that, but there was also acute left heart failure, and ultrasound found that the ventricular wall tumor of the heart was consistent.
After treatment stabilizes the condition, the doctor performs a coronary angiogram on the patient. Contrast showed 100% blockage at the opening of the anterior descending branch of the coronary artery, which is consistent with the location of myocardial infarction and the appearance of ventricular wall tumors, and the right coronary artery also has 70% stenosis. So the doctor opened the blood vessel in the 100% blocked anterior descending branch and placed a stent.
Later, there is the standardized drug treatment.
Go back and look at this case.
Symptoms are often atypical in the elderly when they have a myocardial infarction, and the doctor has to tighten this string in his head.
The elderly, especially people with cerebrovascular disease, smokers, diabetics, inevitably some of the feeling sluggish, a variety of chronic diseases coexist, symptoms are also diverse, once the occurrence of myocardial ischemia, myocardial infarction, chest pain symptoms are not obvious, not typical, easy to misdiagnosis and miss diagnosis.
Therefore, when encountering the elderly, especially the elderly who originally had chronic bronchitis, hypertension, and diabetes, sudden chest tightness, shortness of breath, asthma aggravated, blood pressure also decreased, the original chronic heart failure of the person's condition suddenly aggravated, or the patient has a disorder of consciousness, confusion, irritability, nausea and vomiting, should be vigilant. At this time, do an electrocardiogram to exclude myocardial ischemia and arrhythmias, which is simple and easy.
Why do patients with myocardial infarction develop low-grade fever?
This is due to the fact that after the heart muscle dies, the necrotic substance is absorbed and metabolized by the body. These necrotic substances are toxins and inflammatory substances to the body. In the process of absorption and metabolism, it will stimulate the body to rise in body temperature. In such patients, the laboratory white blood cells will also be elevated. Therefore, elevated body temperature and elevated white blood cells are not necessarily bacterial infections.
Why do patients cough and wheezing after myocardial infarction?
After myocardial infarction, especially after a large-scale myocardial infarction, cardiac function will be reduced. You think! Large pieces of myocardial necrosis no longer work, and the heart's ability to contract is definitely reduced. After the left ventricular myocardial infarction, it affects the blood flowing back from the lungs to the heart, and the blood is stalted into the lungs. The blood in the lungs accumulates, and the water penetrates into the alveoli, affecting the gas exchange; the tracheal wall will also be edematous, and the patient will feel chest tightness and wheezing; the water in the lungs will be discharged, which will stimulate coughing. In severe cases, the patient can not lie flat, need to sit upright, wheezing, coughing, pink foam sputum, this is a very dangerous acute left heart failure.
Therefore, people with diseases in the lungs and trachea can cough and wheezing, and people with heart diseases can also cough and wheez. There is an asthma called "cardiogenic asthma."
It is said that the heart muscle cannot be regenerated after death, so what is the purpose of putting a stent?
The main purpose of stenting after myocardial infarction is twofold, first, to improve blood supply and insurance. Because the patient has two large vascular lesions, the most important one is 100% blocked by the anterior descending branch, if it is not opened, then the left ventricular anterior wall of the myocardium will rely on other blood vessels to open the lateral branch circulation to supply blood. However, the right coronary artery of the other major blood vessel is also narrowed by 70%, which is in short supply, in case the disease is blocked, the collateral circulation is also broken, which is a very dangerous thing. Opened, there is an insurance. Second, awaken the "hibernating heart muscle" and improve heart function. After myocardial infarction, a part of the myocardium in the necrotic ischemic area is not necrotic, but "hibernates" and fakes death. The hibernating myocardium can also wake up and restore normal function after the blood supply improves, so the improvement of blood supply is also to awaken the hibernating myocardium, so that the heart function can be improved.
This is why the heart muscle has been infarctioned and also put a stent. Of course, this is based on the specific condition.
Doctors, health is related, life is entrusted, and it needs to be careful and meticulous. Patients should also understand that when clinical symptoms are atypical, some tests are needed to differentiate.
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