Chapter 1823: with translation of chapter title

"It's fine, old man." Zheng Ren pulled out the old man's venous line and helped him up from the ground.

"Sit down and rest a bit, your condition has been diagnosed." Zheng Ren said with a smile.

"What disease is it diagnosed as?" The old man was a bit cautious and also doubtful.

Looking like that, he was truly afraid of being diagnosed with a mental illness. Consequently, his gaze at Zheng Ren was off, faintly hostile.

"Swallow-induced syncope is a rare neurally mediated type of fainting, associated with life-threatening slow heart rhythms and low blood pressure, usually not easily diagnosed promptly." Zheng Ren said: "After tilt-table testing confirmed it, it's a problem with the vagus nerve."

"……" The old man didn't understand a word.

"Don't say what disease it is, first say how to treat it." Zheng Ren said.

"Old Luan, you say you, are you hurt?" Su Yun came to Luan Yingjie's side, helped him up, and said in a reproachful tone: "You're supposed to be diagnosing your grandfather, what mess are you making there."

"Ugh……" Luan Yingjie painfully covered his wound, laughing and crying at once.

"You almost killed your dad, you clearly saw that situation just now, yet you're stirring up trouble for no reason." Su Yun kept jabbing.

"Um…… sorry." Luan Yingjie didn't know why he got kicked, yet he felt compelled to apologize.

But his grandfather was sitting there perfectly fine, while his own recent actions seemed a bit strange.

Bowing his head, admitting defeat—these are no big deal!

"This condition requires a pacemaker." Zheng Ren said: "A dual-chamber pacemaker, after it's implanted you can eat whatever you like."

"My heart is fine." The old man wondered, "The ECG is right there, why implant a pacemaker?"

"Your heart is fine, but when you eat, the esophagus expands, tugging the vagus nerve, which can cause a few seconds of cardiac arrest." Zheng Ren laughed.

The old man still didn't believe it, but since Zheng Ren didn't say it was a mental illness, his attitude improved considerably.

Elderly people of this age either believe everything or believe nothing; it's obvious Luan Yingjie's father belongs to the latter.

After all, it's surgery; even a minor pacemaker implantation is still surgery.

Zheng Ren smiled, obviously he had taken that into account.

"Old man, how about this?" Zheng Ren said gently: "If you don't want to have a heart pacemaker implanted, that's fine; tomorrow let Boss Luan take you to the hospital for a 24-hour Holter monitor."

"Huh?"

"One day is enough to find the problem." Zheng Ren said, "Then we can consult a few more specialists, and you can decide what to do."

Saying that made the old man feel extremely comfortable.

He stated the diagnosis confidently, yet didn't pressure himself to decide, instead suggesting further checks and seeking more opinions carefully. This young doctor really knows how to get along.

"Mm-hmm, I think that's better." The old man immediately agreed with Zheng Ren's opinion.

"If there's nothing else, we'll be leaving." Zheng Ren said, "Boss Luan, if you decide on surgery, come find me. It's different from ordinary surgery; during the operation we need to test esophageal distension and its impact on the heart."

"Okay, okay." Seeing Zheng Ren and Su Yun stand up, Luan Yingjie hurriedly got to his feet.

His leg went weak, and he fell to the ground.

"Look at you, can't you be a bit more careful? At your age, what if you fracture a bone?" Su Yun didn't help him up, but instead snapped.

Luan Yingjie gave a bitter smile, "This isn't from you kicking me, is it?"

"Don't be polite, we're leaving." Zheng Ren saw the nurse go help Luan Yingjie up, then turned and walked away.

"Boss Zheng, what was the situation just now?" Manager Zhou asked.

"Manager Zhou, ride in your ambulance back to the hospital and give us a lift." Su Yun said with a smile.

"It's fine, fine, what was the situation just now?" Manager Zhou had been preoccupied with the patient's condition of fainting upon eating.

"The inhibitory reflex of esophageal expansion on the heart is a potential pathophysiological mechanism for the patient's fainting. This case report was published in BMCCardiovascDisord." Zheng Ren said: "The author also reviewed and summarized the 101 reported cases of swallow-induced syncope from 1793 onward."

"1793……101 cases," Manager Zhou was speechless.

"This type of fainting is more common in men and the elderly, with an average age of 57.5 years in case reports. 54.5% of patients faint regardless of what they eat, whether liquid or solid food." Zheng Ren said: "Usually it's triggered by esophageal disease."

"So that's how it is." Manager Zhou quietly noted the patient's condition, feeling the paper recording Zheng Lao Ban's recent diagnosis in his chest pocket emit warmth, making him a little excited.

"Implanting a pacemaker is the most common treatment; 98.1% of patients who received a pacemaker reported relief of fainting symptoms, and over half got a permanent pacemaker." Zheng Ren said: "This largely proves that cardiac pacemakers are still useful."

"Implanting a pacemaker……" Manager Zhou pondered the function of a pacemaker.

"Next is treatment for gastrointestinal diseases, such as four patients who had hiatal hernia repair. Others underwent successful vagus nerve ablation, long-term proton pump inhibitor use, and esophageal cancer radical surgery."

"That just scared me." Manager Zhou then came to his senses, touching his chest, still feeling a lingering palpitation.

"Don't be afraid." Zheng Ren laughed: "Look, your first-aid kit has atropine; having this drug means there's no big problem."

"Huh?"

"Atropine was commonly used before pacemakers appeared; limited data show its efficacy can reach up to 90%." Zheng Ren said: "If it weren't for needing to observe for five minutes and see how low the patient's blood pressure could go, we could just push a dose of atropine and see effect in 15 seconds."

"But the blood pressure would be too low." Manager Zhou said.

"Well, my psychological threshold is 35 mmHg; if it drops below that, I must administer atropine." Zheng Ren said: "The patient's condition is fairly cooperative, which is good."

"Boss, you really can keep your cool. My psychological threshold is 40 mmHg; seeing you silent, I also held back." Su Yun said: "But I was anxious inside, kicking Old Luan made me feel much better."

"Don't be so violent." Zheng Ren said leisurely, "Aren't you afraid something might happen?"

"I also saw the atropine. With atropine present, how could anything go wrong? Besides, I'm a thoracic doctor; aside from defibrillation and compression, I have a hundred ways to resuscitate him, what's there to fear!" Su Yun said.

Manager Zhou felt a little embarrassed.

At that time I really was a bit panicked.

Although I knew that if the tilt test were positive there could be danger, but I've never encountered it, and my diagnostic skills are far inferior to those of Zheng Lao Ban and Yun Ge'er.

It's still that my basic level isn't enough; when I go back I'll read more books when I have time, Manager Zhou thought to himself.