Chapter 2383: with translation of chapter title

2388.2302 Headache needs to treat the heart (Alliance Leader Aaxxee extra chapter 3)

Returning to the Intervention Department, Lin Yuan reported everything she knew to Zheng Lao Ban. Previously, she had an episode once; after taking medicine for facial paralysis, she recovered, leaving no sequelae; even the mild headache she considered unimportant she reported to Zheng Lao Ban.

Speaking at greater length and mentioning more symptoms made her appear more conscientious.

Moreover, she did not emphasize that the patient needed surgery, and she herself had not obtained firsthand data. Zheng Lao Ban is the type of person for whom emphasizing anything more is useless, and Lin Yuan knows this in her heart.

"Su Yun, what do you think?" Zheng Ren asked.

"Not smoking, not drinking, and having such a good routine at a young age—what's the point? Life's enjoyment, do you have to wait until you're old to go clubbing?" Su Yun muttered.

For someone who both smokes and drinks, Yang Lixin is the typical embodiment of his opposite, 'evil'.

"I didn't take the medical history well; if Yue Jie went, she would surely know more details." Lin Yuan, seeing that Zheng Lao Ban hadn't lost his temper yet, first self‑criticized and admitted her mistake.

This method works well at home; every time she lets out a meow, she can get past anything. Although Zheng Lao Ban doesn't go for that, Lin Yuan still habitually lets out a meow first.

Perhaps then Zheng Lao Ban might handle things a bit more gently.

"You asked very well; the condition is basically clear." Zheng Ren gave a faint smile.

"Um..."

That statement was harder for Lin Yuan to accept than being scolded badly.

"The condition is clear? Clear as a whistle! What's clear about it— not smoking, not drinking, often staying up late? Or something else?"

"Oh? You suspect a patent foramen ovale?" Su Yun asked, "Is it because of the headache, plus a suspected cerebral infarction, and then a cerebral infarction?"

"If it's just one point, we can't diagnose; if the two points are combined, the likelihood of a patent foramen ovale is high." Zheng Ren said.

Lin Yuan's mind flashed with the diagnostic criteria and clinical symptoms of a patent foramen ovale.

The book clearly states that a patent foramen ovale is usually asymptomatic, murmurs are hard to hear, and ECG and chest X‑ray are normal. Hence, it is not easily detected and is not given much attention.

Lin Yuan even recalled data from years ago stating that, on average, one out of every four to five people has a patent foramen ovale.

Because most patients have no symptoms, the chance of going through life without discovering this condition is especially high.

For a long time people believed that a patent foramen ovale generally does not cause shunting between the chambers and has no effect on cardiac hemodynamics, so they considered it "insignificant".

Is that how Zheng Lao Ban made the diagnosis?

Su Yun glanced at Zheng Ren, who frowned and said, "Boss, did you start suspecting this from the point of cerebral infarction in young people?"

"More or less, one needs a reason." Zheng Ren said, "The probability that a patent foramen ovale causes headache is high; a considerable number of patients with headache are hard to diagnose, and it's all due to the patent foramen ovale."

"Paradoxical cerebral infarction—so that's what you've been suspecting all along." Su Yun smiled, "So you had Xiao Linzi go ask about the medical history?"

"Um, if there's headache, we can likely diagnose paradoxical cerebral infarction; doing a transesophageal echocardiogram… the difficulty is still considerable, and we might also need to do a bubble test."

"Zheng Lao Ban, please wait a moment." Lin Yuan immediately stopped Zheng Lao Ban from speaking further; if he continued, they'd already have the treatment plan, and the case discussion would be drawing to a close.

But she herself had no clue.

Paradoxical cerebral infarction, Lin Yuan knows. Generally, cerebral infarction is caused by arterial thrombosis. But some people have no thrombus in the arterial system, yet a thrombus in the venous system can pass through a patent foramen ovale and lodge in the blood vessels of the brain.

This is also a theoretical basis for the current medical tendency to treat a patent foramen ovale once a paradoxical cerebral infarction is detected.

"Are you asking what the relationship is between headache and patent foramen ovale?" Zheng Ren asked.

"Yes."

"Currently, clinical explanations lack theoretical basis." Zheng Ren smiled and said, "However, there are a few speculations. First, unexplained headaches might be due to some neurotransmitters in the venous system passing through the open foramen ovale, bypassing the pulmonary vessels' deactivation and filtration functions, directly entering the cerebral circulation, where they bind to certain nerve receptors and produce headache symptoms."

"Second, when the foramen ovale does not fully close during deep breathing, coughing, exercise, etc., tiny thrombi in the venous system can pass through it into the cerebral circulation, exacerbating the spread of cortical spreading depression, which is also the onset phenomenon of migraine."

Lin Yuan sighed inwardly, feeling that her diagnostic knowledge was still insufficient.

"When encountering cerebral infarction of unknown cause, recent theory tends to check the heart." Zheng Ren continued, "A patent foramen ovale is also a precipitating factor."

"For cerebral infarction, one should check a cardiac ultrasound, and it's also related to headache…" Lin Yuan sighed deeply again.

"They say you shouldn't treat a headache by focusing on the head or a foot ache by focusing on the foot, but I never expected to be given another lesson today."

Su Yun said, "Do you want to go get a B‑ultrasound yourself?"

"Probably not needed." Zheng Ren said, "Do you know anyone familiar in the Neurology Department?"

"The Inpatient Chief I've dealt with before, but you know how people in internal medicine are—contact isn't deep." Su Yun said, "Should I give you a heads‑up?"

"Um, do a transesophageal echocardiogram or a bubble test—whatever is convenient—to check for a patent foramen ovale. If present, the chance of future episodes is high; just find an interventional physician in Cardiology to plug it directly."

"See how much the Intervention Department delays things—this used to be Thoracic Department work." Su Yun glanced at her own boss, and all her grievances piled onto the boss.

"Cardiology now mainly does cardiac interventional procedures; who do you blame for this?" Zheng Ren said.

"I'll first ask them indirectly whether they've checked; let's not keep ourselves busy here—Neurology already has everything ready for surgery and tests, which would be awkward." Su Yun changed the subject, shifting to another direction.

"That's fine, as long as we don't miss this point. If episodes occur repeatedly and one time it doesn't open, the patient will suffer later." Zheng Ren didn't care, saying it offhand.

Just brushing this matter over like that isn't bad. The possible missed diagnosis will be reminded by Su Yun, raising no suspicion, and Lin Yuan did a good job on this.

"Well, in a few days Fugui'er will leave; I need to properly teach her surgery, and if there are any mistakes, I'll rap them with the hemostatic forceps."

Lin Yuan didn't know that, because of a single headache, she had actually earned Zheng Lao Ban's "attention".