When the Doctor Uses A Hack

Performing electrocardiograms (ECGs) is a skill that emergency physicians, and indeed all physicians, must possess.

After three years of emergency medicine training, Chen Cang’s familiarity with the human body’s lead I to lead VI surpassed his familiarity with the QWER keys on a computer keyboard from his college days playing League of Legends!

Essentially, as soon as you set up the position, you can tell at a glance where to attach the leads, regardless of whether you’re wearing clothes or not.

One of the most common diseases in the emergency department is myocardial infarction, which attacks suddenly and can always turn critical.

So after Chen Cang went to the provincial second hospital, he spent half a year performing and reading ECGs.

At this moment, the ECG machine was sitting nearby, clearly indicating that the patient had just had another ECG done.

Right then, the three of them were all staring at the ECG machine as it slowly and steadily printed out the report.

Meanwhile, Meng Xi’s mind was constantly pondering over the ECG she had just seen. She felt she had seen something like it before but couldn’t quite remember, though it seemed vaguely familiar.

The absence of ST elevation doesn’t necessarily mean the patient doesn’t have non-ST elevation acute coronary syndrome!

An ECG is a screening tool, filtering all diseases through one test, and after the screening, targeted diagnosis and treatment can be administered.

In fact, sometimes the patient’s condition is like solving an applied math problem, requiring logical thinking to deduce.

If a patient comes in with chest pain, your mind should immediately go through all possible causes of chest pain.

Then, through your experience, exams, lab tests, imaging, and so on, you verify or eliminate each possibility.

This is the medical diagnostic process today.

Speaking of which, if this is how Western medicine works, how does Traditional Chinese Medicine approach diagnosis and treatment?

Perhaps everyone thinks Traditional Chinese Medicine is mysterious and enigmatic, but actually, it relies on logical thinking skills, not the so-called nonsense.

Ancient people didn’t understand much about human anatomy and physiological biochemistry testing was not advanced, so you couldn’t just perform surgery on a patient! After all, in those days, a patient might not be sick, but surgery could lead to infection and death…

This was quite normal.

Traditional Chinese Medicine studies the relationship between external presentations and internal pathological changes.

And its diagnostic process involves observation, listening, questioning, and pulse-taking.

To observe and know is called divine; this refers to how many famous doctors, with rich experience and broad knowledge, can diagnose just by looking at a patient’s behavior, complexion, body shape, tongue appearance, and so on.

And after hundreds of years of summarizing case studies through various observations, listening, questioning, and pulse-taking, the Traditional Chinese Medicine diagnostic science was established.

Through observation, listening, questioning, and pulse-taking, one verifies each sign to arrive at a fitting syndrome, thereby diagnosing and treating to achieve the goal of spotting the subtle to perceive the apparent!

Sometimes, one can’t help but marvel at the greatness of the ancients.

…

The ECG results had just come out, and Chen Cang was about to hand it to Meng Xi, but upon taking it in his hand, he suddenly paused!

Because this ECG… was a bit different!

Firstly, there was a 1-3mm depression at the J-point in the precordial V1-6 leads, with the ST segment sloping downwards and the T-waves symmetrically pointed!

Secondly, the QRS waves were normal, not widened at all.

Finally, there was a mild elevation of the ST segment in the aVR lead.

After carefully looking it over again, Chen Cang suddenly considered a possibility!

Could it be… His face changed as the thought crossed his mind!

After thinking it over carefully again, it seemed very likely!

Seconds later, Chen Cang combined the patient’s conditions and age among other factors, and contemplated the patient’s possible condition.

Turning around, Chen Cang hurriedly passed the ECG in his hand to Meng Xi.

Meng Xi took it and couldn’t help furrowing her brow; it still looked similar to the one before.

Could it really be NSTE-ACS (Non-ST Elevation Acute Coronary Syndrome)?

Chen Cang had thought that, as a female doctorate from abroad, Meng Xi would have some understanding, but seeing her hesitate like this, he grew anxious.

With that in mind, Chen Cang directly said, “Professor Meng, I think the patient’s ECG closely resembles de Winter syndrome! We must arrange further examinations as soon as possible, to facilitate further treatment!”

Without any hesitation, now was not the time to doubt, because such an ECG pattern belongs to the hyper-acute phase of ST-segment elevation myocardial infarction! This is what’s known as: de Winter syndrome.

After Chen Cang said this, both of them were momentarily stunned!

Upon hearing this term, Ge Huai also paused for a moment, it seemed somewhat familiar!

This type of ECG pattern is rarely summarized in China, it was de Winter and other cardiologists from Rotterdam who, through retrospective study of 1532 cases of acute LAD proximal occlusion ECGs, found that 30 patients did not show typical ST-segment elevation. After their research, they identified several special ECG waveforms and later published their findings in the New England Journal of Medicine.

This is the so-called de Winter syndrome!

However, since this syndrome is relatively new, there might not be many references in domestic literature, which is why many doctors are not very familiar with it.

Reminded by Chen Cang, Meng Xi’s expression suddenly changed, de Winter?

Yes!

It closely resembles it!

It’s very likely!

With this in mind, Meng Xi hurriedly took the ECG report and continued to compare it.

The more Meng Xi looked, the more alarmed she became, the more anxious she felt.

Turning to look at Ge Huai, she quickly said, “Dr. Ge, hurry up and put through the orders, complete the relevant tests, get ready to sign off… as quickly as possible…”

If it was confirmed, then timely coronary intervention to open the occluded vessels and save the viable myocardium was imperative!

Currently, the indications for thrombolytic therapy in myocardial infarction are mainly based on ST-segment elevation magnitude and whether there is a new complete left bundle branch block. Although de Winter syndrome is a complete or sub-complete occlusion near the proximal LAD, the ECG does not meet the criteria for thrombolytic therapy.

Theoretically, thrombolytic therapy might be effective, but at this stage, it remains “off-label” use. A look through the STEMI guidelines of recent years, both domestically and internationally, also does not mention this category of patients.

What does that mean? Any disease, when receiving treatment, needs to follow the treatment indications.

And this de Winter syndrome is not within the indications for thrombolytic therapy, so if something goes wrong, it is the doctor’s responsibility.

But medicine is continuously evolving, who can guarantee that nothing will go wrong?

As a doctor, one must exercise the surgical scalpel in hand with precision!

Upon hearing this, Ge Huai promptly got up to start making an array of arrangements!

Time ticked away, and Chen Cang busied himself alongside Meng Xi and Ge Huai!

When the coronary angiography imaging results came in, the three of them turned solemn!

Indeed, it was so!

It truly was de Winter syndrome!

Now that a diagnosis was made, urgent arrangement of the intervention surgery was needed.

Meng Xi led her team in a flurry, hastily commencing the treatment of the patient without delaying by even a minute. By eleven o’clock, the patient’s surgery was finally complete.

The surgery went smoothly!

A precious life was thereby saved through a perfect rescue.

The three couldn’t help but be overwhelmed with emotion!

At that moment, Chen Cang heard in his ear:

[Ding! Meng Xi favorability +15!]

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