Practicing Medical Skills in a Small Clinic novel Chapter 69

Chapter 69: 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.

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."

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