Chapter 1933: 1865 Just Stop the Drug

"How? Is the heart function not good?" Zheng Ren asked.

"The left ventricle is hypertrophied, and heart failure has already set in." Su Yun said, "If this were in the United States, they would definitely be added to the waiting list for a heart transplant and start queuing for a donor."

"Echocardiography diagnosis of left ventricular hypertrophy also needs to be combined with ECG; otherwise the error is relatively large." Zheng Ren was still looking at the films, but he kept talking nonstop.

"In New England, there is a case report showing that the patient has obvious limb lead low voltage, and the QRS wave amplitude is even lower than the P wave."

"The ECG seems difficult to associate with left ventricular hypertrophy, but the echocardiography examination shows significant left ventricular hypertrophy. Ultimately, through magnetic resonance and biopsy testing, the diagnosis was confirmed as 'myocardial amyloidosis'."

"Boss, you're a general surgery doctor, why are you so interested in our cardiothoracic research?" Su Yun didn't rebut; he also knew this.

It seems that in the future, when speaking with the boss, one must be careful; otherwise, catching a loophole will leave oneself speechless.

Other departments having thick skin is fine; but if cardiothoracic is rebuked by the boss, how embarrassing.

Su Yun thought to himself.

"Isn't it different?" Zheng Ren said: "The contradiction in diagnosing left ventricular hypertrophy between ECG and cardiac ultrasound lies in their different mechanisms."

The former reflects whether myocardial cells are hypertrophic through cardiac electrophysiological reflex activity; the latter evaluates through subjective measurement of the ventricular wall.

Cardiac magnetic resonance is expensive, but its repeatability, sensitivity, and tissue specificity are clearly superior to the previous two, which helps with etiological differentiation. However, cardiac nuclear magnetic resonance—there aren't many of those nationwide, are there?

"You think this is in Hai Cheng? Now even prefecture-level cities have cardiac nuclear magnetic resonance." Su Yun seized the loophole in Zheng Ren's words and began to look down on him, "It's just a bit pricey, ranging from 6000 to 10000."

"Oh, that's not bad." Zheng Ren put down the films and started looking at the lab report.

"Diagnosing left ventricular hypertrophy with ECG is actually not bad. The examination is simple and easy; many domestic and international hypertension guidelines recommend ECG as a detection method for left ventricular hypertrophy, but its sensitivity is low—sensitivity for mild and moderate/severe left ventricular hypertrophy is 7%–35% and 30%–60%, respectively."

Su Yun said while looking at the patient's ECG.

"One also cannot be so arbitrary; compared to sensitivity, its specificity is higher, with specificity for severe left ventricular hypertrophy diagnosis reaching 80%–90%. Obesity may affect ECG diagnosis of left ventricular hypertrophy, increasing the miss rate."

"Speaking of sensitivity, echocardiography diagnosis of left ventricular hypertrophy is more sensitive than ECG; through the corrected left ventricular mass index, left ventricular hypertrophy can be detected. The most commonly used LVMI is LVM divided by body surface area, using the Devereux correction formula… Do you know the Devereux correction formula?"

Zheng Ren casually asked while looking at the lab report.

"Boss, I'm the rising star of cardiothoracic surgery; who are you talking to?" Su Yun said disdainfully, "The Devereux correction formula—I can calculate it mentally."

"Brother Song, does the patient's family have any intention of treating?" Zheng Ren suddenly asked.

"Yes." Song Ying didn't understand what Zheng Ren meant.

Just now, Zheng Lao Ban and Su Yun had been discussing professional jargon for half a song; things like the Devereux correction formula—Song Ying didn't understand a bit.

Not to mention him; even someone like Chang Yue, a clinical doctor, is like a duck hearing thunder.

But why did Zheng Lao Ban ask whether the patient's family had any intention of treating?

"That's how it is; the liver isn't a big problem, the main issue is still the heart." Zheng Ren smiled and said, "If the heart problem were in the United States, they'd directly prepare for a heart transplant. But you know our situation—there aren't many heart donors in a year, and the elderly person's condition definitely couldn't last that long."

Song Ying frowned; he didn't understand what Zheng Ren said.

Zheng Ren thought it over and felt his logic was flawed. Song Ying, after all, isn't from a medical background; but relying on talent, after searching online, he could know a bit about the situation.

But if the patient's condition were to be explained to him, it would have to start from the very beginning, bit by bit.

"Then let's start from the beginning." Zheng Ren picked up the lab report and said, "Medications include apixaban, bumetanide, diltiazem, aspirin, amiodarone, and milrinone. Aside from shortness of breath, the patient's vital signs are within normal range."

I looked at the medical record; it says the elderly person has had arrhythmia for 30 years, and has been taking amiodarone for treatment.

Song Ying nodded; before coming, he had also done some work understanding the elderly person's medical record.

After all, coming to Zheng Lao Ban to look at the films, not understanding anything said, is generally not good. Leaving a good impression on Zheng Lao Ban is necessary.

"Liver function is abnormal: ALT 176 U/L, AST 236 U/L, ALP 104 U/L, bilirubin 1.5 mg/dL, albumin 2.6 g/dL. I guess the local doctors ordered a plain liver CT scan because of this, and that's how they discovered the problem."

"Although there was no intravenous contrast injection—that is, what we often call enhanced imaging—the abdominal CT scan showed the liver very bright, like a light bulb. The plain abdominal CT scan indicated liver density >100 Hounsfield units, suggesting a large amount of radiopaque dense substance deposited in the elderly person's liver parenchyma."

"……" Song Ying saw that Zheng Ren didn't consider the bright liver a big deal, and was somewhat taken aback.

"These substances are actually just deposits from drug metabolism; it's nothing." Zheng Ren said very calmly: "Amiodarone is a class III antiarrhythmic drug. It has mild non‑competitive antagonism of α and β adrenergic receptors, and also possesses mild class I and IV antiarrhythmic properties."

"I won't go into the specific drug mechanism; simply put, as the name suggests, amiodarone contains iodine elements."

Song Ying more or less understood that sentence.

The contrast agent contains iodine, which Song Ying knows, so enhanced CT makes the required organs bright, while also providing doctors with more information.

"At the molecular level, amiodarone contains two iodine atoms, accounting for 40% of its molecular weight."

Furthermore, amiodarone accumulates in the body over a long period because its half‑life is long; research shows its half‑life is between 2 and 4 months. Because the pH gradient allows amiodarone to form hydrophobic bonds with polar lipids, amiodarone molecules are captured in lysosomes.

This way, amiodarone can escape degradation by phospholipases and remain longer inside the cell.

Zheng Ren explained bit by bit.

"It's said that even after stopping the drug for half a year, blood drug concentration can still be measured." Su Yun added a sentence.

"Mm, that's basically it." Zheng Ren said: "This liver is due to long‑term oral amiodarone causing iodine deposition."

"The problem isn't big; after stopping the drug it will gradually recover. But the main problem is still the heart."