"Dr. Liu, what’s the exact situation?" Xu Guosheng, the chief physician of the cardiology departnt, arrived at the ergency departnt.
"Dr. Xu, this patient has a two-year history of epilepsy. Other hospitals diagnosed it as idiopathic epilepsy," Liu Banxia quickly explained.
"He had three seizures today. The second one occurred in the ambulance and lasted for 27 seconds. The third one happened in the ergency departnt. Two minutes into the seizure, we injected two units of lorazepam. He recovered 3 minutes and 17 seconds later."
"When the monitor was first connected, there was an instant when his blood pressure and heart rate dropped to zero, then recovered. I suspect ventricular fibrillation occurred at that mont, but it happened too quickly to serve as a definitive basis for diagnosis."
Xu Guosheng frowned. "Are you saying the epilepsy was cardiogenic? Adams-Stokes syndro?"
Liu Banxia nodded. "If it wasn’t an equipnt issue during connection, then that’s highly possible. However, there are no clear indicators at the mont, so I had to ask you to co over."
"Ah... this is quite troubling," Xu Guosheng sighed.
"Cardiac conditions can sotis be quite peculiar. All we can do now is an echocardiogram to observe cardiac dynamics and ejection fraction. Then, let’s have him wear a Holter monitor to get a dynamic electrocardiogram."
"If he has another seizure today, we should be able to capture the data. Otherwise... My god, you’re not really planning sothing that risky, are you?"
Seeing the intense look in Liu Banxia’s eyes, Xu Guosheng was sowhat unnerved.
Liang Xiaolin and the others were extrely curious. It wasn’t just them; even Wang Chao was all ears. It had to be sothing major, otherwise Xu Guosheng wouldn’t be so agitated.
"Dr. Liu, it’s not that I can’t help you make this diagnosis, but the patient is too young. A guardian must be present. We also need to obtain the guardian’s consent; otherwise, we’ll both be in trouble," Xu Guosheng said helplessly.
"Teacher Liu, Teacher Xu, what exactly are you talking about? Can you clear up our confusion?" Xu Yino couldn’t hold back any longer.
"Your beloved Teacher Liu here intends to perform a cardiac induction. If it’s indeed as he suspects and the induction is successful, it will definitely show up in the tests, and then targeted, precise examinations can be conducted," Shi Lei spoke up.
"However, this procedure is sowhat risky. The child has no history of heart disease. During the induction process, not only would he suffer considerably, but an otherwise healthy person might even suffer a heart attack."
With Shi Lei’s explanation, everyone understood. Artificially inducing a cardiac event was actually a standard procedure, but it was generally perford on patients suspected of having a history of heart disease, or at least those who had experienced symptoms like chest pain or a rapid heartbeat.
Now, with this child having been diagnosed with idiopathic epilepsy at other hospitals, their own Teacher Liu was planning to induce a cardiac event. This idea was truly audacious.
Liu Banxia rubbed his nose. "I have my reasons. We administered two units of lorazepam, but even then, the active seizing only stopped after more than a minute."
"It’s precisely because we can’t yet be sure. That montary flatline on the monitor—that wasn’t a glitch, was it? So I think we can consider it from this angle."
"Of course, we can put the Holter monitor on him first. Then, when his parents arrive, I’ll discuss it with them. His current epilepsy must already be having a significant impact on his life."
"Hmm... dressing as a little girl... perhaps he’s trying to get more attention. He might already be ostracized at school, whether intentionally or unintentionally. After all, with his condition, no one can really play with him."
"Dr. Liu, if there’s no other way, just wait for his guardian to arrive and then reconsider. But I urge you to be cautious. Things are a bit chaotic in the hospital right now, and getting a complaint wouldn’t be worth it," Xu Guosheng advised.
"Yes, President Liu, if worse cos to worst, let’s just observe him more. He’s already had three seizures today. If we actually put him through the tests, what if a cardiac event isn’t triggered, but he has another epileptic seizure instead?" Wang Chao also chid in.
Liu Banxia nodded. "I will definitely give it more thought."
This choice was indeed difficult. But he said what he said; once the child’s parents arrived, he would still give this recomndation. It wasn’t because of that mission—the mission would, at most, provide so experience and increase his proficiency in diagnostic skills. He was doing it for this patient.
Being surrounded by strange looks, being ostracized—that kind of feeling must be awful. And he truly didn’t believe the monitor had malfunctioned, or that Liang Xiaolin hadn’t attached the electrode pads properly at the beginning.
But as for how confident Liu Banxia was about this, he didn’t have much; it was rely a suspicion. It was a judgnt of probability based on what he had observed today.
Without clear indicators, all diagnoses were just conjectures—essentially, shots in the dark.
First, an echocardiogram was perford; everything seed normal. Then, the patient was fitted with a Holter monitor, hoping to find sothing on the dynamic electrocardiogram. Furthermore, Wang Chao was assigned to the patient’s bedside; today, he was to watch only this patient.
"You really have guts. Although I also think what you’re saying is sowhat possible, I wouldn’t dare recomnd that to the child’s parents," Shi Lei said.
"What makes you so sure I’ll tell the child’s parents?" Liu Banxia asked curiously.
"Don’t I know your personality? Is everything settled with the dical affairs departnt?" Shi Lei retorted.
Liu Banxia nodded. "I saw they were trying to shift the bla, so I shut them down directly. It has nothing to do with personal grudges; it’s mainly that this matter cannot be handled that way."
"Whatever their original intentions were, I’m just going to assu that’s what they were thinking. It was originally a very simple matter; why complicate it?"
"Then you should still take it easy. You could easily end up with a complaint," Shi Lei said.
"Chief, with my personality, do you think I could just let a patient leave in such an uncertain state? Would I feel right about that?" Liu Banxia said helplessly.
"If it weren’t for the monitor flatlining, and the fact that we had to inject lorazepam—which still took over a minute to stop the active seizing—I wouldn’t be giving this so much thought. What if I’m right? The next ti he has an attack, there might not be enough ti to save him."
Shi Lei glanced at him and nodded.
What Liu Banxia said was true. However, considering the current state of doctor-patient relationships, even if you were acting in the patient’s best interest, if the examination results remained inconclusive, it would likely lead to patient dissatisfaction.
After waiting for nearly another half hour, the patient’s parents finally rushed over.
Once they had seen the patient, Liu Banxia pulled them aside and explained his suspicions to them.
"Doctor, are you certain?" the patient’s father hesitated before asking.
"We’ve taken him to many hospitals for examinations, but all the conclusions have been the sa: they all said it’s characteristic epilepsy. They also said it might disappear as he gets older."
"Initially, I considered that too. However, today the child had three seizures in a very short period. I think this is sowhat different from previous episodes, isn’t it?" Liu Banxia asked.
The child’s mother nodded. "Previously, he only had occasional attacks. We just had to protect him, make sure he didn’t bump or hit himself, and he would recover quickly."
"For the last episode today, we had to use dication, and even then, it took a full 3 minutes and 17 seconds for him to return to normal," Liu Banxia continued.
"I have reason to suspect that the child’s epilepsy may be caused by a cardiac condition. We’ve perford an echocardiogram, and didn’t find anything untoward with his ejection fraction or morphology."
"So, considering these circumstances, I believe it might be seizures triggered by arrhythmia due to Adams-Stokes syndro. The onset is typically between the ages of 7 and 40, and it has a hereditary component."
"The pathogenic chanism of this condition is that an issue in a specific part of the myocardium leads to arrhythmia, causing supraventricular tachycardia. In other words, the heart beats so rapidly that not enough blood is supplied to the brain, leading to cerebral hypoxia, which in turn causes seizures."
"Hereditary? Inherited from whom? We’re both fine," the patient’s father asked with surprise.
"Even if it is inherited, it just ans there is a certain probability of onset. Moreover, this is currently just my hypothesis. I just think that the child’s seizures today were too frequent, and after ruling out other causes, this is the only one left," Liu Banxia explained.
"Moreover, if we hadn’t connected the monitor today and seen it flatline on the display, I wouldn’t even be considering this possibility."
"How do we test for it, doctor?" the patient’s father asked.
"Initially, I was planning to conduct so tests to make a judgnt, by inducing an event. However, I’ve just reconsidered. We can opt for a more direct approach: a cardiac electrophysiology study," Liu Banxia said calmly.
"However, this is an invasive interventional procedure. It involves testing the heart muscle’s response by applying electrical stimulation. If a specific point or a bundle of myocardial fibers is diseased, it will be imdiately apparent."
"This examination is more precise and is the most thorough one we can perform. While an echocardiogram also provides images, it offers a more macroscopic view and cannot reveal underlying issues in the absence of organic lesions."
"Invasive examinations also carry certain risks, so please consider it carefully. For the sake of preventing your child from being ostracized in the future, and more importantly, for his safety, if you feel it’s worth trying, I will then explain the procedural steps and risks to you."
This was indeed the result of Liu Banxia’s careful consideration. His original plan had been to conduct tests gradually, but that approach might exhaust the parents’ patience and end up being a lot of wasted effort.
However, this new proposal of his was more direct and audacious, making Shi Lei, who was standing nearby, break out in a cold sweat for him.
The principle normally followed in hospitals was to proceed with examinations from less invasive to more invasive—for example, starting with an ultrasound, followed by X-rays, then CT scans, in that diagnostic sequence.
This ti, the examination Liu Banxia recomnded could be called the ultimate test—and an invasive interventional one at that. If the patient’s family had a temper, they would undoubtedly file a complaint if the test found nothing wrong.
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