Practicing Medical Skills in a Small Clinic-Chapter 69: Successful Diagnosis
The viral infection of the heart can not only cause viral myocarditis and explosive myocarditis but also infective endocarditis.
Li Jingsheng has now ruled out the possibility of myocarditis, as many symptoms don’t align; thus, the last remaining possibility is that the patient has infective endocarditis.
Firstly, myocarditis occurs in the myocardium, while endocarditis occurs in the endocardium, with the valves being the most commonly affected areas.
During the patient’s auscultation, the coarse, loud heart murmur, supported by the Master Level skill in Cardiovascular Medicine diagnosis, assures him that if it’s just a slight valve insufficiency, it couldn’t cause such a loud noise.
This indicates that the valve is not only insufficiently closed but is likely also damaged by viral invasion.
Analyzing the symptoms, early-stage viral or bacterial infection of the endocardium usually shows insignificant fever, only beginning to elevate once the condition progresses. Or intermittent low fever.
The fever typically lasts long, with an irregular pattern, possibly accompanied by night sweats, loss of appetite, joint pain, and other symptoms.
Due to valve damage, a heart murmur is often heard at this time, manifesting as coarse and loud.
This also aligns highly with the patient’s symptoms.
Additionally, the progression of infective endocarditis is often mild, without the terrifying explosive myocarditis.
It often presents precursor symptoms before onset.
This similarly highly coincides with the patient’s disease progression.
Li Jingsheng, through repeated inferences, gradually clarifies the patient’s cause of disease.
"Normally, diarrhea won’t lead to infective endocarditis because the heart has a rather strong defense network. However, when the patient’s valve itself is insufficiently closed, it gives the virus endless opportunity to invade. Diarrhea often occurs due to bacteria invading the human digestive tract, such as the common E. coli and Salmonella.
The patient’s chest pain started appearing the second day after diarrhea, gradually worsening afterward.
This indicates the virus causing diarrhea likely invaded through the insufficiently closed heart valve, eventually causing infective endocarditis."
After layers of differential diagnosis, Li Jingsheng finally clarifies the patient’s pathogenesis and cause of illness.
Having clarified the pathogenesis and cause of illness, there’s another daunting task: persuading the patient to go to a big hospital overnight for further examination and treatment.
After about ten minutes, the programmer guy came out, supporting himself against the wall.
It seems he was nearly exhausted from diarrhea.
Looks like his diarrhea is quite severe.
"Dr. Li, sorry for making you wait. I don’t have any major heart problems, right? Could you just give me some anti-diarrhea meds? I have to be at the company at six tomorrow morning because my boss wants the project completed before eight."
The patient spoke weakly.
Severe diarrhea can easily lead to dehydration and electrolyte imbalance. It’s crucial to hydrate timely.
Some people believe drinking water might worsen diarrhea, but there’s no scientific basis for this. In fact, not replenishing water, leading to dehydration, can cause many adverse reactions and extreme harm.
Also, diarrhea is actually a form of the body’s self-protection mechanism.
It expels a large amount of virus and necrotic cellular tissue through diarrhea, greatly benefiting body recovery.
Just like how a cold patient nearing recovery always has a lot of pus-like nasal mucus over a few days.
That can similarly be understood as detoxification.
"I’ve just diligently reviewed your condition, course, symptoms, and the cause of your illness. The conclusion is quite severe. First, I suspect your heart valve has insufficiency. Second, I suspect the bacteria causing your diarrhea has infected the heart endocardium, causing significant damage to the heart valve. Third, your condition is rapidly progressing, with potential risks of cardiogenic sudden death or cardiac arrest. 𝚏𝗿𝗲𝐞𝚠𝕖𝐛𝗻𝗼𝐯𝕖𝚕.𝚌𝗼𝗺
Overall, I strongly advise you to immediately go to a big hospital for overnight consultation; just register for emergency care directly.
These are my provisional diagnosis results and suspected cause, all written down; when you register for emergency care, if the attending doctor doesn’t pay attention or asks you to queue for a long time, you can directly show this to the nurse or doctor; they should open a green channel for you."
Li Jingsheng once worked at a big hospital, and is very familiar with the emergency procedures.
Sometimes the doctor on night duty might be an intern.
Cardiovascular Medicine diagnosis itself is extremely difficult; if this guy is unlucky and meets a careless doctor who just does a hasty examination and says, "No major issues, take some meds, rest at home, return as necessary."
This guy would definitely trust the diagnosis from hospital doctors more.
Additionally, his work urgency.
At that point, he would most likely go home, take meds, and rest; the consequences would be unimaginable.
Li Jingsheng has written down his diagnostic thoughts, as long as the attending doctor doesn’t treat human life carelessly, it will surely attract some attention.
At the very least, they’d conduct further examinations on him, and even consult the duty’s senior doctor.
"Is it...that serious?"
The patient doesn’t understand the professional terms, but from Li Jingsheng’s serious expression and heavy tone, he can feel the seriousness of the issue.
"I can’t claim my diagnosis is 100% correct, but at least I strongly suggest you follow my advice. Here isn’t far from the Second Hospital, you can simply take a taxi there. I advise against walking there; in your current situation, you should avoid over-exertion, or it could worsen heart burden, and the condition might rapidly deteriorate. Then, treatment difficulty will greatly increase, costs will multiply, and treatment duration will stretch significantly."
Li Jingsheng answered sternly.
"Well...alright! I’ll follow your advice and take a cab to the hospital now."
The patient was somewhat frightened by his words.
It’s a matter of life and death; it’s impossible not to take it seriously.
"Don’t delay; getting to the hospital quickly is imperative. Also, if your family is around, it’s best to notify them to come over. If no family is around, you could find a trusted friend."
If surgery is necessary, signing and caregiving by family would surely be needed.
Even though Li Jingsheng is unfamiliar with cardiac surgery, the possibility of surgery is high considering the patient’s heart valve insufficiency and significant noise.
"Alright, thank you!"
The patient nods gratefully at Li Jingsheng and heads out.
After exiting, he quickly pushes the glass door open again, sticks his head inside, "Dr. Li, can I go to work at six tomorrow morning?"
"Stop thinking about work, saving your life should be the priority. Besides, once checked by the big hospital, if no major issues are found, you can surely return to work, and if there are problems, just inform your boss and take leave; your boss will surely understand."
Every striving individual has their struggles.
This guy’s already terribly ill, yet his mind still worries about timely work completion.
"Alright, goodbye!"
This time the patient truly left, hailed a taxi outside, and got in.
Seeing this, Li Jingsheng breathed a sigh of relief, with a smile appearing on his face.
He doesn’t regret losing a sale of anti-diarrhea medication.
On the contrary, he feels particularly gratified, from the bottom of his heart, hoping for this young person striving alone in a big city to remain safe.
When the big hospital’s admitting doctor sees the diagnostic note written by Li Jingsheng, how would they react?
Initially, there’d surely be doubt: could a small clinic doctor diagnose such a challenging cardiology condition?
Then when the results are confirmed, if the patient truly has infective endocarditis, the big hospital’s doctors might be left only with shock.
