My Medical Skills Give Me Experience Points Chapter 1424 - 567: Special Myocardial Infarction Patient, Systemic Arterial Vascular Malformation (Part 2)

After a thorough review, Zhou Can was able to formulate a precise rescue plan instantaneously.

"Contact the cardiac catheterization room immediately and send the patient over. I'll go speak with the family," he instructed.

Director Lou, too, acted with unusual swiftness.

...

Following an arduous rescue lasting close to two hours, Zhang Qilian's life was preserved. However, the extended period of ischemia meant he was destined to suffer severe long-term complications.

These included heart failure, arrhythmia, and ventricular aneurysm, among others.

The primary issue would be heart failure.

From this point forward, even a short walk would leave him gasping for breath, drastically diminishing his quality of life for the remainder of his days.

The only viable recourse would be the implantation of an artificial heart or a heart transplant.

Both myocardial infarction and cerebral infarction result in irreversible damage.

Indeed, prolonged ischemia affecting any bodily tissue carries the potential for permanent harm.

Nevertheless, certain areas possess unique characteristics; even if major blood vessels become obstructed, collateral arterial vessels might still supply blood. In such scenarios, the body might exhibit severe symptoms, but with prompt medical intervention, sequelae are often mitigated.

The interventional thrombectomy performed on Zhang Qilian proved exceptionally challenging.

His vascular system presented peculiar difficulties.

The interventional team encountered failure whether attempting access through the femoral artery, radial artery, or percutaneous coronary artery.

It was ultimately Zhou Can who intervened. Employing his Level 6 Injection Skill and Level 6 Implantation Technique, he finally identified the root cause of the problem.

It turned out that along the pathway from Zhang Qilian's femoral artery to his coronary arteries, two points exhibited severe arterial plaque buildup. This caused significant narrowing, particularly at a sharp bending point where the obstruction was quite pronounced.

This condition made the passage of the guidewire through the vessel an incredibly arduous task.

Had the obstruction been confined solely to the femoral artery approach, the interventional specialists would not have been deterred. They could have simply opted for the radial artery approach.

In clinical emergencies, the radial artery approach is commonly favored.

Regrettably, the path between Zhang Qilian's radial artery and his coronary arteries was even more severely compromised, with the vessel displaying profound malformations. Such a condition is exceedingly rare in medical practice.

At the very least, it was the first time Zhou Can had witnessed a patient with such extensive vascular malformations.

Furthermore, during his performance of coronary angiography, he observed equally severe malformations within the patient's coronary arteries themselves.

This led him to question whether the patient's entire systemic arterial network suffered from this pathological change, or if it was perhaps a congenital anatomical anomaly.

The definitive cause would necessitate further investigation at a later time.

It was no wonder the Japanese cardiac surgery expert from the Third Hospital had been stumped by such a unique vascular condition.

Through this challenging procedure, Zhou Can's confidence in his interventional treatment capabilities grew substantially.

Unbeknownst to others, his interventional skills had already surpassed those of many seasoned 'experts'.

As he exited the cardiac catheterization room, Zhou Can had already mentally reconstructed Zhang Qilian's entire clinical journey, from onset to treatment.

It was likely that during a court proceeding, Zhou Can had achieved a stunning victory, one that Zhang Qilian found difficult to accept.

At his advanced age, compounded by severe systemic arterial disease, a powerful emotional shock would have caused his blood pressure to surge. This, in turn, would have exacerbated the vascular blockage, ultimately triggering the myocardial infarction.

Some might ponder: when blood pressure rises, shouldn't blood circulation intensify, leading to more open blood flow? So, how could a heart attack occur instead?

The underlying pathogenesis must be examined from multiple perspectives.

Firstly, hypertension can accelerate the progression of atherosclerosis, directly leading to arterial narrowing.

Given Zhang Qilian's severe, widespread arterial vascular disease, it is highly probable that this was a consequence of prolonged periods of high blood pressure.

Secondly, inadequately controlled long-term blood pressure frequently results in damage to target organs, including enlargement of the left ventricle.

Following left ventricular enlargement, its capacity to pump blood effectively diminishes.

Imagine a house initially built for a family of three, feeling comfortably occupied. If, one day, the house were expanded significantly in volume, yet still housed only three people, it would feel cavernously empty.

The heart's ventricle functions similarly.

With an enlarged ventricle, the volume of blood entering remains constant, naturally leading to a reduced ejection capacity.

Concurrently, ventricular enlargement can weaken the myocardium, which is another significant factor contributing to reduced pumping efficiency.

If this enlarged left ventricle is left unaddressed, over time it will impede blood supply to the heart muscle itself, thereby significantly increasing the risk of coronary spasms.

Should these conditions be present, a sudden elevation in blood pressure due to patient stimulation could cause unstable atherosclerotic plaques to break loose. This could lead to the formation of a thrombus, which would ultimately obstruct the coronary artery.

Therefore, when speaking with patients diagnosed with heart disease, careful consideration of one's language is paramount.

Words that are too harsh can elevate a patient's blood pressure, placing them in a precarious situation.

In instances where someone is angered to the point of death, there's a significant likelihood of facing legal repercussions.

Zhang Qilian's defeat in court caused his blood pressure to surge, ultimately resulting in a myocardial infarction, tragically.

His own medical institution specialized in cardiac surgeries, making it his preferred choice for treatment. However, he had no inkling that the Japanese cardiac surgery virtuoso, employed by the hospital at a substantial salary, would prove so inept.

In the moment of crisis, they failed him yet again.

Despite their persistent endeavors, they were unable to extract the thrombus or clear the blockage in the coronary artery.

They found themselves utterly helpless.

Following discussions with the family and Vice Dean Zhang, a decision was made to place their trust in Tu Ya's medical expertise, and the patient was directly transferred to Tu Ya for emergency intervention.

Their choice turned out to be remarkably astute.

After more than two hours of dedicated work by Zhou Can, two stents were meticulously placed along the path from the patient's femoral artery into the coronary artery. This action propped open the severely constricted vessels, enabling the guidewire to navigate through without impediment.

The thrombectomy procedure was successfully executed.

According to Zhou Can's assessment criteria, he believed the patient would necessitate the implantation of at least a hundred stents throughout his entire vascular system.

Even with such extensive intervention, a complete resolution of the condition might still be elusive.

Zhang Qilian continued to face the inherent risk of arterial blockages.

Regardless of the broader implications, he had succeeded in saving the patient's life, an accomplishment that would undoubtedly amplify his renown once more.

As they exited the catheterization room, the patient's family members converged around.

"Doctor, how is my husband?"

Zhang Qilian’s wife appeared remarkably youthful, maintaining her appearance exceptionally well, adorned with impeccable makeup.

Were it not for the subtle nasolabial folds, faint crow's feet, and eyes that seemed incongruous with her youthful visage, Zhou Can might have mistaken her for someone in her twenties.

Her skin possessed not only fairness but also a particular luminosity.

Her physique was equally well-preserved.

She projected an aura of gentle intelligence.

Considering Zhang Qilian's notoriously ruthless and deceitful character, coupled with his less-than-handsome features, it was truly surprising that he had married such a beautiful woman. It brought to Zhou Can's mind the apt idiom, "Fine flowers often adorn coarse dung."

"The patient is presently out of immediate mortal danger. However, his systemic arterial vascular disease is exceedingly severe. He must exercise extreme caution henceforth and absolutely avoid becoming agitated. Given that he arrived late and missed the optimal window for intervention, post-recovery, he may experience heart failure and will be unable to engage in strenuous activities or intense physical exertion."

Zhou Can and Zhang Qilian could be considered rivals.

Yet, whether during the critical rescue or in the present moment, he embodied the sacred and noble spirit inherent in the medical profession.

He consistently prioritized the well-being of his patients above all else.

"Sugoi!"

Upon hearing this assessment, she clasped her hands together, a radiant smile gracing her features.

It was evident she held Zhang Qilian in high regard.

Their affection for each other appeared remarkably tender.

Her utterance of Japanese moments earlier, a seemingly subconscious reflex, suggested her likely origin from Japan.

Acting on instinct, his gaze drifted towards her legs.

Indeed, a discernible bow-legged curvature was present.

"Thank you, thank you all!"

She conveyed her profound gratitude to Zhou Can repeatedly.

"You are most welcome! You will be able to see the patient shortly. He will likely require hospitalization for approximately three to seven days."

Zhou Can offered a nod in her direction before proceeding to depart.

...

The subsequent day, subsequent to completing his morning ward rounds in the Emergency Department, Zhou Can made a specific visit to ascertain Zhang Qilian's recovery progress.

Just as he reached the cardiovascular ward, his attention was caught by a familiar figure.

Vice Dean Zhang, who had been escorted away by security personnel on a previous occasion, was observed standing outside the ward, engaged in a phone conversation.

As vice dean, with the current incapacitation of the dean, his responsibilities must undoubtedly be substantial.

Upon noticing Zhou Can's approach, a subtle shift manifested on Zhang Mingxing's countenance.

It was predominantly an expression of unease.

"Good morning, Dean Zhang!"

Zhou Can offered a cordial greeting, accompanied by a smile.