Man heart palpitations chest tightness, thought the heart rate is abnormal, until the gastroscopy found abnormal: the doctor missed diagnosis

2022-07-16 0 By

A reader shared with me his miraculous medical treatment experience. In fact, his condition is not rare, it does happen in clinical practice. In order to help more people, I have compiled his experience and shared it with you today.It happened last year, 2021.Male patient, 30 years old.A few months ago, the patient began to occasionally feel palpitation, that is, the heart will suddenly jump, accompanied by a sense of chest pressure, with professional terminology is called “palpitation, chest tightness”, the patient initially thought that the heart is not good.Only 30 years old, the heart is not good, think of all scared urine, after all, heart disease is no small thing, no matter how small heart disease may make people miserable, serious heart disease or even sudden death, can not worry about it.We need to go to the hospital.The doctor gave him a careful auscultation of his heart, also did an electrocardiogram, found no obvious problems, even a slightly faster heart rate, which does not mean anything.Some people have a rapid heart rate when they see a doctor, which is caused by physiological stress.Finally the doctor asked, do you have the habit of drinking strong tea and coffee?Yes, two cups of coffee a day.Quit, strong tea and coffee are likely to affect the heart, some people who are sensitive a drink it will arrhythmia, because strong tea and coffee contain caffeine, but it is well known that caffeine is a stronger material stimulates the central nervous system, cardiovascular system, so drink strong tea drink coffee can be refreshing, apes can continue to stay up late working procedure, is to rely on these two items.You may wonder why caffeine, the stimulant in strong tea, is called caffeine, but you can understand why caffeine in coffee is also called caffeine.Very simple, strong tea can refreshing, the Chinese have known since ancient times, but do not know what is the biological active substance.Later, someone discovered that there was a substance in coffee that could refresh you. It was detected to be a kind of alkali, which was named caffeine (theine). Then this substance was also found in tea, which was the same substance as coffee, so it could only be called caffeine, not strong tea.The doctor also said that a lot of people with heart trouble are not easy to see through the ECG, because the ECG only describes the time of a minute or so, and a lot of heart trouble is intermittent, sometimes not attack, not when you do ecg is useless.But he was prescribed metoprolol tartrate tablets, which is a beta-blocker, the heart’s many beta receptors, and once blocked, the heart’s activity is suppressed, which can be used to treat tachycardia.A lot of arrhythmia, hypertension people have to take this medicine, very common, quite widely used a drug.The patient listened to the doctor, went home and gave up coffee.Take your medicine, too.Sure enough, it got better.Later, due to busy work, also did not take this matter to heart.But two months later, the symptoms returned, the familiar palpitations, the agonizing, sudden, startled, pounding of the heart for several minutes, five or six times a day, even worse than before.The pills didn’t help.Seriously affect the life and work.I hurried back to the hospital.As a result of the last experience, he deliberately chose the most uncomfortable time to do electrocardiogram and cardiac ultrasound, but still did not find the problem.I don’t know.The doctor says the likelihood is to break out too short, burst burst stops, although you still have afflictive feeling, but actually arrhythmia has passed, so electrocardiogram does not catch.Well, the metoprolol tartrate tablets prescribed last time are short-acting drugs, one pill can only be administered for a few hours, which may not stop your arrhythmias. This time, let’s change to a long-acting drug, called metoprolol succinic acid sustained release tablets (or metoprolol, but in a different form), one pill can be administered for 1 day, which should work.Before he left, he also took the pills of instant salvation.Heart palpitations that kind of feeling is really bad, really feel like dying.The patient himself was scared.In fact, quickeffect Jiuxin pill is used for coronary heart disease, and arrhythmia, but the person is urgent scold niang, take in case.When she got home, she looked it up and found that she might have a problem with her botanic nerves, a disorder that can also cause palpitations and other symptoms.Alleged plant nerve, everybody may not understand quite, say simply a few autonomic nerve that controls viscera namely, include sympathetic nerve and parasympathetic nerve.If something goes wrong with them, the gut feels and moves poorly, so it is possible to suspect that a neurotic disorder is causing palpitations.The question is why is there a vegetative disorder?I don’t know.Patient oneself also do not know of course, then oneself added some of B group vitamin, grain wei element to wait, try to can improve plant nerve function.Disappointingly, this time all the drugs combined had no effect.Nothing worked, and the patient continued to experience palpitations and near-death feelings.I feel terrible.There was no choice but to continue to seek medical treatment.After a few months land land off and on did 10 times examination, 24 hours dynamic electrocardiogram also went up, why should do this examination, last time the doctor is not to say, arrhythmia may be burst burst stop, common electrocardiogram is impossible just good stepping on that point, cannot discover abnormality so.The 24-hour ELECTROcardiogram, as its name suggests, covers 24 hours, and it can pick up arrhythmias within 24 hours.Unfortunately, there were still no significant problems, except for the occasional high heart rate.This completely affects work and life.Doctors suggest that you may want to do more 24-hour amBUlatory electrocardiograms, more than a few times, the probability of detection is greater.You can even do an electrophysiological examination, where you put electrodes directly into the esophagus and stimulate the heart near the esophagus to see if you can induce an arrhythmia, and if you can, then you can do radiofrequency ablation to burn off the lesion.Arrhythmia is like a thief, the thief always wait until the night when the wind is high and the light is dim before coming out to commit the crime, after the quick hiding, the police can not take him (similar to electrocardiogram).All right, so step up patrols, 24-hour patrols, but even then, there’s still a way for thieves to evade police patrols and do it behind their backs.What can I do in the end?There is only one way, to find out the thief, can only be door-to-door registration visit, this is called the initiative, this is like electrophysiological examination, directly near the heart, stimulate the heart (knock registration), if there is a problem will be induced.Because it’s a — the patient’s not saying yes.When I got home, I continued to take the pills, and the symptoms went back and forth.An accidental opportunity, he drank wine at night, in the middle of the anti acid, afflictive, find used panxi tora azole (a drug inhibition of gastric acid secretion, used for the treatment of peptic ulcer disease) to eat a piece of, my day, panxi tora azole down after a whole day is not bad, heart palpitations is miraculously disappeared.At first, I thought it was accidental, not connecting palpitations with pantoprazole.But chest symptoms recurred over the next few days, with occasional acid reflux, and then another dose of Prilosec, which went away for a few days.That’s weird.The patient is starting to lose his composure.Speculation can be in the esophagus or bad led to the chest in the stomach afflictive? (I still wary very smart), after all the stomach and heart get close (is actually the esophageal and cardiac get closer, look at the picture), kidney stones before time will also be involved in testicular pain together? (oh my god, what patients over the years have been through, I smiled with malicious intent.Patients are probably right, especially about the kidney stones.Visceral innervation is complicated and often overlapped. For example, one nerve may innervate several organs, which may cause interference to the brain. In fact, it is the problem of A, and the brain sometimes thinks it is the problem of B, so subjectively, it will show the pain of B.Kidney stones are typically painful in the kidney area and lower back. Ureteral stones can also cause renal colic or ureteral colic, which can also radiate to the testes and labia.According to this statement, the patient is really likely to be stomach and esophageal problems caused by heart trouble ah.He eventually went to the hospital for a thorough gastrointestinal examination, which also led to a painless gastroscopy, and sure enough, the problem was found: a cardia lesion.The biopsy indicated chronic inflammation with acute active inflammation.The problem was finally found.In the end, it was the patient who found the problem and saved himself.As a result of patient existence esophagus and the chronic inflammation of gastric mucous membrane, estimate gastritis first, cardia has reflux, gastric acid can flow into esophagus conversely, long esophagus can have inflammation.Some people may not know what is called cardia, cardia is a level of the esophagus into the stomach, if the cardia relax, the food of the esophagus into the stomach, if the cardia clamp, the food can not fall down, at the same time, the stomach of gastric acid can not reflux into the esophagus.Cardia is a pass, to ensure a smooth exit, certainly do not let in.So you can get the esophagus to the stomach by going along it, not the other way around.But normal people occasionally have acid reflux, is not tight cardiac performance.Below certain pathological circumstance, cardia flab, gastric acid is easy to reflux esophagus, can cause esophagitis.This is gastroesophageal reflux disease.The more common manifestations of GERD are heartburn, reflux, laryngitis, chronic cough, asthma and so on.In rare cases, arrhythmias can be triggered because the esophagus is so close to the heart that when the esophagus is stimulated it can easily touch the heart and trigger arrhythmias, such as atrial fibrillation or paroxysmal supraventricular tachycardia.People with these arrhythmias have palpitations, chest tightness, and feelings of near-death.So why is there no abnormality at 24 hours of eKG?There are a couple of reasons. One is that there was no seizure for 24 hours, so it wasn’t caught, and that requires repeated 24-hour EMGS.The other is that the patient may not have obvious arrhythmia at all, and may simply be disturbed by the vegetative nerve function caused by the stimulation of the heart by reflux, not necessarily the result of significant arrhythmia.Anyway, palpitation and chest tightness of patients are definitely related to gastroesophageal disease. Why?Because he went home and took esomeprazole for a while, got rid of palpitations, chest congestion, and heart rate.This treatment is very effective, backwards, it is absolutely certain that gastroesophageal reflux induced heart discomfort.See, the patient suffered for such a long time. It turned out to be a digestive tract problem, not a heart problem. Unfortunately, after seeing so many doctors, they did not find this.And that’s not unusual, because the doctors are all over the place, and the out-patients are so busy that they don’t have a lot of time to think about the patient, like an assembly line, next, next.In the doctor’s eyes, this is just a patient.But from the patient’s own point of view, that is their whole life, the two sides of the energy and time are far different.It is not impossible for patients to learn their own clues and make a final diagnosis, which is why popular science is needed.It is helpful for doctors and patients to strengthen science popularization and let everyone know more about diseases.Doctors do not have to avoid anything, missed diagnosis is missed diagnosis, no one can live a lifetime without misdiagnosis and missed diagnosis.Acknowledge generously that the patient helped you, and then reflect on whether you, too, might be spending more time with a patient who has been back and forth several times with no results, or if the diagnosis went awry, so that you can reverse course in time.Gastroesophageal reflux disease (GERD) is a disease in which gastroduodenal content flows back into the esophagus, causing unpleasant symptoms and complications.Reflux and heartburn are the most common symptoms.According to whether causes the esophagus mucous membrane erosion, ulcers, is divided into reflux esophagitis, non erosion reflux disease.The disease can also cause damage to larynx, airway and other tissues adjacent to the esophagus, with extra-esophageal symptoms, such as pharyngitis, chronic cough, asthma, dental erosion, and occasionally arrhythmias, such as atrial fibrillation and supraventricular tachycardia.Diagnosis was made by gastroscopy, 24-hour esophageal pH monitoring, and esophageal manometry.The most critical treatment is to inhibit gastric acid secretion therapy (such as pantoprazole and omeprazole in this paper), promote gastrointestinal motility (such as domperidone and moxapride) and other drugs, and even surgery is needed for serious cases.In addition, patients should pay attention to not immediately after eating bed, do not eat chocolate, coffee, strong tea, etc., because these foods will reduce the pressure of the esophageal sphincter, and cause reflux.(End of article)