Rebirth 1977 Great Era

Chapter 1117 A Real Troll vs. a Fake Gentleman, On the Brink of Death (Bonus Chapter for Monthly Tickets: 3K Chapters)

“He’s being modest,” Fang Yan said to Zheng Tongmin with a smile.

After saying that, he looked at the middle-aged woman next to him. Among these people, she was the only one with a sickly appearance. Her brows were furrowed, and her energy seemed to be weaker than that of a normal person.

"Come on, sit here. Let me get a basic understanding of your situation." Fang Yan pointed to the area in front of the consultation table, gesturing for the patient to come over.

The patient nodded, looking somewhat nervous.

After the patient sat down, Fang Yan also sat down in his seat. Then Zheng Tongmin took a file folder from his person, handed it to Fang Yan, and said:

"This is the medical check-up we had in Hong Kong before we came back."

Fang Yan took it and confirmed that it indeed contained only the latest medical examination report. As he pulled out the report to look at it, he asked:

"Is there a big difference between the previous reports and this one?"

He didn't ask about the previous report directly, but instead inquired about the comparison. Actually, the report wasn't that important to Fang Yan. What he mainly wanted to know was how much Zheng Tongmin's wife cared about her health in the past.

If you undergo a lot of examinations, it means you are paying close attention to your health, and your physical condition may have changed significantly.

If you don't get enough checkups, you might not pay as much attention to your health, and heart problems might have less impact on your daily life.

Zheng Tongmin, upon hearing about the dialect issue, said:
"There are some differences from the previous reports. We need to have physical examinations four times a year. Sometimes when we feel unwell, we need to go to the hospital for examination immediately. After all, our health is our own. People with sick family members understand this even more deeply."

Hearing him say that, Fang Yan confirmed that they did value their health.

"What has changed?" Fang Yan asked.

Zheng Tongmin said:
"Atrial fibrillation, ST-T changes, chest X-ray shows generalized cardiac enlargement."

Fang Yan looked at the report, which showed that it was a test conducted by St. Mary's Hospital in Hong Kong.

In the upper right corner was a one-inch bareheaded photo of the patient. The woman in the photo had a slightly furrowed brow and fine lines at the corners of her mouth, and she looked just like the person in front of me, with the weariness of a long illness.

The first page of the report was a printed electrocardiogram, with wavy curves violently vibrating on the graph paper.

The speaker pointed to the ST segment with the tip of a pen: "ST segment depression of 0.1-0.2mV in leads II, III, and aVF, T wave inversion... typical signs of myocardial ischemia."

At this moment, the surrounding traditional Chinese medicine practitioners also gathered around, including the He family father and son.

Fang Yan ignored them, turned the page, and saw that on the black and white echocardiogram, the heart's outline looked like an inflated balloon, with the left atrial diameter measurement marked in red:

42mm, exceeding the normal upper limit of 35mm.

The dialect indicates that this is the basis for the diagnosis of 'generally enlarged heart'.

"It's obviously dilated cardiomyopathy!" He Dong said with certainty.

Everyone turned to look at him, and He Dong asked:
"how?"

Jin Wubing said irritably:

"What business is it of yours if Dr. Fang is seeing a patient? Are you trying to show off?"

Jin Wubing had been annoyed with this guy who looked down on him for a long time. Plus, the two were close in age, so Jin Wubing felt like he was going to get annoyed if he didn't confront him.

"What did you say?" He Dong was shocked. How could this guy be so barbaric, starting a fight with him in front of so many people?

Kim Moo-bing raises his middle finger:
"Shit, is there something wrong with your ears?!"

He's someone who's not afraid of trouble at all. Besides, he thinks he's helping Fang Yan save face. Gang leaders all have people like that around them. After all, how could a leader go and argue by himself? That would be too embarrassing!

He simply couldn't stand it, and regardless of what the other party thought, he started to argue back.

Seeing that the situation was escalating, Fang Yan said to them:

"Okay, stop making trouble!"

After saying that, Jin Wubing turned his head away and ignored He Dong. He Dong pointed at Jin Wubing and asked his father, as if to say, "Why is there such a thing here?"
He Jingwei glanced at Jin Wubing and then at Fang Yan, then shook his head at his son, signaling him not to act impulsively.

He Dong had no choice but to give up. He straightened his suit and tried his best to maintain his composure, but his face was frighteningly gloomy.

The people around watched, each with a different expression on their face.

Fang Yan really didn't take He Dong seriously. The more he tried to show off, the more it showed that he was a simpleton, couldn't keep secrets, and his thoughts were written all over his face, so people could tell at a glance.

As for Jin Wubing, this guy is just a pure, foul-mouthed version of Ji 2.0. He doesn't think too much and just spouts whatever he doesn't like.

He Dong perfectly restrained his desire to appear elegant.

He turned his head back to the examination report, this time flipping to:

Ejection fraction 38%.

The accuracy of dialect recognition should be above 55%, which indicates that the heart's pumping function has indeed declined.

He turned to the last page. In the blood routine and biochemical indicators, only the low-density lipoprotein cholesterol (LDL-C) showed 5.2 mmol/L, marked with "↑".

Hong Kong doctor's conclusion:

The patient has a 17-year history of atrial fibrillation and now shows signs of heart failure.

At this moment, Jin Wubing said:

"It doesn't mention anything about dilated heart disease on this."

Chen Mike, who had studied Western medicine, chimed in:
"The diagnosis of dilated cardiomyopathy (DCM) requires ruling out other specific causes, such as hypertension, coronary heart disease, and myocarditis. Its core is 'unexplained ventricular enlargement and decreased systolic function'."

"Mrs. Zheng's enlarged heart and decreased ejection fraction are typical manifestations of DCM. The report also shows a 17-year history of atrial fibrillation, ST-T changes due to myocardial ischemia, and elevated LDL-C indicating the risk of arteriosclerosis. These factors may all be the cause of heart failure."

"The doctor probably thought that the current tests had not completely ruled out other clear causes, so he did not directly diagnose DCM, but summarized the current state as 'signs of heart failure'. This is to leave room for subsequent investigation of causes. Generally speaking, clinical judgment should be more cautious."

Jin Wubing turned around and said to He Dong:

"Hehe...kid, did you hear that?"

"Are you never going to stop?" He Dong glared at Jin Wubing.

Jin Wubing raised an eyebrow, shrugged, and defiantly gave the middle finger.

"Fang Yan, aren't you going to do anything about this guy?" He Dong said to Fang Yan.

Fang Yan turned to look at him and then said:

“You are all guests, why should I care about anyone?” “Don’t disturb my doctor’s appointment,” Fang Yan said to He Dong.

He Dong nearly choked to death; he couldn't refute Fang Yan's words.

He felt that Fang Yan didn't take him seriously at all; this guy didn't help his relatives at all, and he clenched his fists in anger.

Fang Yan completely ignored He Dong and continued to question the patient:
How do you usually feel? What treatments have you undergone?

The patient thought for a moment and said:

"After taking Chinese medicine for several years, I only felt palpitations and anxiety when I was thinking too much or when I was tired. Recently, my symptoms have worsened. I have chest tightness, short sleep duration, and I keep having dreams. I also feel weak all over and don't want to do anything."

"I saw a Western doctor in Switzerland and they gave me some Western medicine."

"Oh right, I brought them all with me this time."

As she spoke, Zheng Tongmin, who was behind her, had already taken out a small bag and placed it on the Fangyan table.

He Dong glanced at Jin Wubing, who was already mocking him, and knew that if he said anything, he would be "bitten". So he could only shut up and suppress his urge to speak.

After opening the bag, everyone saw several bottles and jars, but Fang Yan quickly recognized them as amiodarone, quinidine, and digoxin.

Amiodarone is a class III antiarrhythmic drug (potassium channel blocker) and also possesses the characteristics of class I, II, and IV antiarrhythmic drugs.

Amiodarone can dilate coronary arteries, increase myocardial blood supply, and reduce peripheral vascular resistance, thus reducing the burden on the heart. Doctors may hope to reduce the frequency of atrial fibrillation attacks and improve palpitation symptoms by using amiodarone.

However, long-term use of this product may cause thyroid dysfunction, pulmonary fibrosis, and liver damage.

Quinidine is an antiarrhythmic drug, but it has a fatal side effect: it can cause torsades de pointes ventricular tachycardia.

Digoxin is a cardiac glycoside drug, belonging to the category of fast-acting cardiac stimulants.

The patient's ejection fraction was 38% (normal >55%), indicating signs of heart failure. Digoxin can rapidly improve myocardial contractility and relieve symptoms such as chest tightness and fatigue.

However, this thing has a narrow treatment window, making it prone to poisoning.

Fang Yan looked at the list and found that all three drugs were used with the goal of "controlling atrial fibrillation and improving heart failure", but they all had certain risks and limitations.

He asked the patient in a dialect:
"So how did you feel after using it?"

The patient shook his head and said:

"At first, the medication worked well, but later it stopped working and even caused some side effects. I don't dare to take it casually, but I also don't dare to throw it away."

"I just wanted to come back as soon as possible and see if I could get you to help me get better. I heard that you are very good at treating heart disease, and one of your business partners was cured by you."

Fang Yan asked while writing the medical record:
"Did Chu Qiaonan tell you that?"

Mrs. Zheng nodded:
"Yes, I told my husband, Lao Zheng."

He said in dialect:

"Yes, she's back this time too, with you all."

"Really?" Mrs. Zheng asked, somewhat surprised.

Zheng Tongmin was also somewhat surprised.

He said in dialect:

"His name is Li Chengzhu. He'll be at the table next to you when we eat."

Zheng Tongmin then realized:
"Oh, is that the one who came back with people from the European pharmaceutical company?"

He nodded in dialect.

Zheng Tongmin glanced at his wife's face, then, remembering Li Chengzhu, said:

"You can't tell at all that she has a heart condition."

He said in dialect:

"He's cured now."

Zheng Tongmin said:
"Then please take a look at my wife."

Fang Yan said to Mrs. Zheng:
"Stick your tongue out so I can see it."

"Take my pulse with your left hand too."

Next, Fang Yan observed that the patient's tongue, when protruded, had a dull color and a thin white coating.

Upon examining the pulses of both hands, it was found that the pulses were irregular and intermittent.

"Irregular pulse" is a relatively special pulse pattern in traditional Chinese medicine diagnosis. Its appearance often indicates a serious abnormality in the heart or the circulation of qi and blood.

The pulse of the knotted pulse is characterized by "slowness with occasional pauses, and the number of pauses is not fixed" (the pulse is slow, with occasional pauses in the middle, and the intervals between pauses are irregular).

The pulse feels like "pearls falling on a jade plate, with occasional gaps": the pulse beats slowly (less than 60 times per minute), but the rhythm is irregular, with sudden pauses followed by a continuous beating. The intervals between pauses are irregular, like pearls occasionally getting stuck while rolling down the plate.

It is commonly seen in arrhythmias such as atrial fibrillation and atrioventricular block, or in cases of phlegm-dampness or blood stasis obstructing the heart vessels.

The pulse of the intermittent pulse is characterized by "slowness with occasional pauses, and the pauses are of a fixed number" (the pulse is slow and the pauses are regular).

The feel is like "a water clock dripping water, stopping at regular intervals": the pulse beats slowly and pauses regularly (e.g., stopping once every 7 beats), with relatively long pauses, just like the timed pauses when water drips from an ancient water clock.

It is commonly seen in severe organic heart diseases, such as cardiomyopathy, myocardial infarction, and physiological intermittent pulse caused by pregnancy reactions. It is less common in cases of severe deficiency of qi and blood, such as after major surgery or postpartum.

Under normal physiological conditions, healthy people rarely experience intermittent pulse. If you really want to feel for it, you can only detect intermittent pulse briefly after strenuous exercise or emotional excitement.

In most cases, the appearance of this thing is related to organic lesions or severe deficiency of qi and blood. It is a "pathological pulse" that can be basically diagnosed as soon as it appears.

In this situation, the patient has a high probability of experiencing cardiogenic syncope.

After figuring out the dialect, I couldn't help but feel anxious.

This is on the verge of death!

P.S.: I currently owe everyone 23000 words after finishing this chapter.

That's all for today, please come early tomorrow.

(End of this chapter)