A reader shared with me his miraculous medical experience, in fact, his situation is not rare, clinically it does happen from time to time, in order to help more people, today his experience is sorted out and shared with you.
It happened last year, 2021.
Male patient, 30 years old.
A few months ago, patients began to feel occasionally flustered, that is, the heart will suddenly jump, accompanied by chest pressure, in technical terms called "palpitations, chest tightness", the patient at first thought that the heart was not good.
Only 30 years old, the heart is not good, think about it are scared to urinate, after all, the heart disease is no small matter, no matter how small the heart problem may make people miserable, serious heart disease and even sudden death, can not worry.
I had to go to the hospital.
The doctor carefully listened to his heart, and also did an electrocardiogram, but did not find obvious problems, that is, the heart rate was faster, which also did not explain anything. Some people have a fast heart rate when they see a doctor, which is caused by physiological tension.
Finally, the doctor asked, is there a habit of drinking strong tea and coffee?
Yes, drink two cups of coffee a day.
Quit it, strong tea and coffee may affect the heart, some sensitive people will have arrhythmias when they drink this thing, because strong tea and coffee contain caffeine, and as we all know, caffeine is a relatively strong stimulation of the central nervous system, cardiovascular system of the substance, so drinking strong tea and coffee can refresh the mind, program apes can continue to stay up late to sell their lives, it is by these two things.
You may not understand why the refreshing substances in strong tea are called caffeine, and the caffeine in coffee can be understood, why is strong tea also called this name. Quite simply, strong tea can refresh the mind, Chinese know it since ancient times, but do not know what the bioactive substances in it are. Later, someone found that there is a substance in coffee that can refresh the mind, which is tested to be an alkali, named caffeine (caffeine), and then this substance is also found in the tea, and coffee is the same substance, so it can only be called caffeine, can not be called strong tea cause, which is a first-come, first-served problem.
The doctor also said that many people with heart discomfort are not easy to see through the electrocardiogram, because the electrocardiogram only depicts the time of that minute or so at that time, and many of the heart discomfort is intermittent, sometimes there is no seizure, and it is useless to do the electrocardiogram when you do the seizure.
But the doctor still prescribed him a drug, metoprolol tartrate tablets, this drug is a β receptor blocker, many β receptors in the heart, once blocked, cardiac activity will be inhibited, can be used to treat tachycardia. Many people with arrhythmias and high blood pressure have taken this medicine, a very common, widely used drug.
The patient listened to the doctor and gave up coffee when he got home. Eat the medicine at the same time.
Sure enough, it got better.
Later, due to busy work, I did not take this matter to heart anymore.
But 2 months later, the symptoms came again, the familiar palpitations, it was so uncomfortable that suddenly, it was as if it was frightened by a heavy shock, and then the heart fluttered and beat wildly for a few minutes, 5-6 times a day, the situation was even more serious than before.
Taking the medicine doesn't work.
Seriously affected life and work.
Hurriedly went to the hospital again.
Because of his last experience, he deliberately chose the most uncomfortable time to do electrocardiogram and cardiac color ultrasound, but still did not find a problem.
This is not clear.
The doctor said that the attack may be too short, sudden abrupt, although you still have uncomfortable feelings, but in fact, the arrhythmia has passed, so the ECG can not catch.
In this way, the last time the metoprolol tartrate tablets are short-acting drugs, a pill can only be managed for a few hours, may not be able to control your arrhythmia, this time we change a long-acting drug, called metoprolol succinate extended-release tablets (or metoprolol, but the form of the preparation is not the same), a drug can be managed for 1 day, should work.
Before leaving, I also brought a quick-acting heart-saving pill.
The feeling of palpitations is really uncomfortable, and there is a real feeling of dying. The patient himself is afraid. In fact, the quick-acting heart-saving pill is used for coronary heart disease, not arrhythmia, but people are anxious to scold the mother, bring it just in case.
After returning home, the patient consulted the information himself and found that he may have a problem with the autonomic nerve, and the autonomic nerve disorder can also cause symptoms such as palpitations. The so-called autonomic nerves, which may not be well understood, are simply some autonomic nerves that control internal organs, including sympathetic nerves and parasympathetic nerves. If something goes wrong, the visceral sensations and movements are uncomfortable, so it is also possible to suspect that a autonomic disorder is causing palpitations.
The question is why is there a autonomic disorder? I don't know.
Of course, the patient himself did not know, so he added some B vitamins, oryzanol, etc., in an attempt to improve autonomic nerve function.
Disappointingly, this time all the drugs added together did not work.
There was no effect at all, and the patient still had palpitations and a sense of imminent death as always.
It's terrible.
There was no way but to continue to seek medical treatment.
In the following months, more than a dozen examinations have been done, and the 24-hour Holter electrocardiogram has also been on, why do you want to do this test, didn't the doctor say last time, the arrhythmia may be sudden, and the ordinary electrocardiogram cannot just step on that point, so there is no way to find abnormalities. The 24-hour electrocardiogram, as the name suggests, is 24 hours long, as long as there are arrhythmia attacks during these 24 hours, it can be captured.
Unfortunately, no significant problems have been found, except for the occasional fast heart rate.
This time it completely affected work and life.
Doctors recommend that you may do a 24-hour Holter electrocardiogram a few more times, and do it a few more times, and the probability of detection is greater. Even do an electrophysiological examination, directly use electrodes to go deep into the esophagus, stimulate the heart near the esophagus, see if you can induce arrhythmias, if you can, then find a way to do radiofrequency ablation surgery to burn the lesion.
Arrhythmias are like thieves, thieves always wait until the night when the black wind is high and the lights are blind before they come out to commit crimes, and after they are successful, they quickly hide, and the police can't take him (similar to an electrocardiogram). Well, then step up patrols, patrolled 24 hours a day, but even so, thieves still have a way to evade the patrols of the police and get behind their backs. What can be done in the end? There is only one way, if you want to get the thief out, you can only go door to door to register and visit, which is called active attack, which is like an electrophysiological examination, directly near the heart, stimulating the heart (knocking on the door to register), if there is a problem, it will be induced.
Since this is one, the patient did not agree for the time being.
After returning home, I continued to take my medicine, and the symptoms were repeated.
By chance, he drank wine at night, acid was reversed in the middle of the night, it was extremely uncomfortable, he found pantoprazole (a drug that inhibits gastric acid secretion, used to treat stomach ulcers and other diseases) that he had used before, and he ate a piece, my God, pantoprazole went down, and he did not feel uncomfortable for a whole day, and the palpitations miraculously disappeared.
At first, I thought it was an accident and didn't connect palpitations and pantoprazole.
However, after a few days, chest symptoms still recurred, occasionally there was acid reflux, and then I ate omeprazole again (also a drug that inhibits gastric acid secretion, used to treat stomach ulcers and other diseases), and the symptoms disappeared for several days.
It's so weird.
The patient is starting to be uneasy. Guess whether it is bad in the esophagus or stomach that causes chest discomfort (the patient himself is still very vigilant and smart), after all, the stomach and heart are very close (in fact, the esophagus and the heart are closer, see the picture), and the kidney stones in the past will also involve testicular pain (Oh my God, what the patient has experienced over the years, I laughed with ill will).
The patient's guess is likely to be correct, especially in the renal stone section. Because the internal organs innervation is more intricate, there will often be overlapping innervation, for example, a nerve may innervate several organs, then it may cause interference to the brain, in fact, it is the problem of A, the brain sometimes feels that it is a problem of B, so subjectively it will be manifested as the pain of B. The typical pain of kidney stones is lower back pain in the renal region, and ureteral stones can also be renal colic or ureteral colic, and can also radiate to the testicles and labia.
According to this statement, the patient is really likely to be heart discomfort caused by stomach and esophageal problems.
Eventually he went to the hospital for a thorough gastrointestinal examination and a painless gastroscope, and sure enough, he found the problem: cardia lesions.
Biopsy suggests chronic inflammation with acute active inflammation.
The problem was finally found.
In the end, it is the patient who finds the problem himself, it is he who saves himself.
Due to the presence of chronic inflammation of the esophagus and gastric mucosa in the patient, it is estimated that there is gastritis first, there is reflux in the cardia, gastric acid will flow into the esophagus, and there will be inflammation in the esophagus over time. Some people may not know what is called cardia, cardia is a checkpoint for the esophagus to enter the stomach, if the cardia is relaxed, the food of the esophagus enters the stomach, if the cardia is clamped, the food cannot fall, and the stomach acid in the stomach cannot regurgitate into the esophagus.
The cardinal gate is a pass, to ensure that you can get out smoothly, and you will definitely not let you in. In this way, the road from the esophagus to the stomach can only be followed, not reversed. But normal people will occasionally have acid reflux, which is a manifestation of the cardia not closing tightly. In some pathological cases, the cardia is loose, and the stomach acid is easily regurgitated to the esophagus, which will cause esophagitis. This is gastroesophageal reflux disease.
The more common manifestations of gastroesophageal reflux are heartburn, reflux, laryngitis, chronic cough, asthma, etc. Rarely, arrhythmias may be induced because the esophagus and the heart are next to each other, and it is easy to touch the heart when the esophagus is stimulated, triggering arrhythmias, such as causing atrial fibrillation or paroxysmal supraventricular tachycardia. People with these arrhythmias will have palpitations, chest tightness, and feelings of imminent death.
So why did the patient do the 24-hour ELECTROCARDI and found no abnormality? There are several reasons, one is that there is no seizure for just 24 hours, so it is not captured, which requires repeated 24-hour Holter. The other is that it is possible that the patient does not have a significant arrhythmia at all, and may simply be uncomfortable with autonomic dysfunction caused by reflux stimulation of the heart, and may not necessarily be the result of a significant arrhythmia.
In any case, the patient's palpitations and chest tightness must be related to gastroesophageal diseases, why? Because he went home and honestly ate esomeprazole for a while, he completely said goodbye to palpitations and chest tightness, and his heart rate was not fast. This treatment is very effective, and when pushed backwards, it is completely certain that the heart discomfort induced by gastroesophageal reflux is completely correct.
Look, the patient's discomfort for such a long time, it turned out to be a problem of the digestive tract, not a heart problem, but unfortunately, so many doctors did not find this, and finally the patient found the problem by himself. This is actually not uncommon, because the level of doctors is uneven, and the outpatient doctors are too busy to give them a lot of time to slowly think about the patient's situation, just like the assembly line, next, next.
In the eyes of the doctor, this is just a patient. But in the eyes of the patient himself, that is the whole of his own life, and the energy and time invested by the two sides are far different. It is not impossible for patients to find clues and traces by learning themselves, which is why science is needed. Strengthening science popularization and making everyone more aware of the disease is helpful for doctors and patients.
Doctors do not have to be afraid of anything, missed diagnosis is missed diagnosis, no one can not miss diagnosis for a lifetime. Generously admit that the patient himself has helped himself, and then reflect on whether he also has to spend more time on a patient who has been re-examined several times before and after but still has no effect, whether the diagnosis is wrong, only in this way can he reverse the course in time.
Popular Science Small Class:
Gastroesophageal reflux disease is a disease in which the contents of the gastroduodenum regurgitate into the esophagus cause uncomfortable symptoms and complications. Reflux and heartburn are the most common symptoms. According to whether it causes erosion and ulceration of the mucosa of the esophagus, it is divided into reflux esophagitis and non-erosive reflux disease. The disease can also cause damage to adjacent tissues of the esophagus such as the throat and airway, and there are extraesophageal symptoms, such as laryngitis, chronic cough, asthma, erosion, etc., and occasionally cause arrhythmias, such as atrial fibrillation, supraventricular tachycardia, etc.
Diagnosis is by gastroscopy, 24-hour esophageal pH monitoring, and esophageal manometry.
The most critical treatment is to inhibit gastric acid secretion therapy (such as pantoprazole, omeprazole, etc.) in this article), promote gastrointestinal motility (such as domperidone, mosalpride) and other drugs, and seriously require surgery. In addition, patients should pay attention to the fact that they should not lie in bed immediately after eating, and do not eat chocolate, coffee, strong tea, etc., because these foods will reduce the pressure of the esophageal sphincter and cause reflux.
(End of this article)