Chapter 74: Dyspnea (4)

“Doctor! He was moved to the treatment room!”

As soon as Suhyuk reached the nursing station, he heard the shrill voices of nurses. It sounded like screams, and understandably so. A patient who had just undergone some invasive procedure now showed low blood pressure. Even if it wasn’t a medical error, there must be a connection with the treatment.

“Treatment room. Understood. Dahoon, you go ahead and check on him first. I’ll follow immediately.”

“Yes, sir!”

Dahoon stopped trying to support Suhyuk and rushed towards the treatment room.

Fortunately, it wasn’t yet a code blue situation requiring cardiopulmonary resuscitation. However, Suhyuk felt that at least one doctor should already be present in the treatment room.

Tap.

Tap.

After Dahoon left, Suhyuk swiftly waved his cane.

[Shouldn’t you be faster than this now? Aren’t you being too lazy with your practice?]

‘Shut up, damn it. You dare say that to someone with a bad leg?’

[I mentioned it because anger tends to increase your speed. Indeed, your velocity increased by approximately 11%.]

‘Ugh.’

Suhyuk was becoming progressively quicker. Although he hated to admit it, this improvement might have been due to Baruda’s influence. His speed certainly spiked whenever he got angry.

“Hmm.”

Upon reaching the treatment room, they found the patient already transferred onto a bed. Dahoon arrived first and held a tube, contemplating whether intubation was necessary. However, no matter how one looked at it, it seemed unlikely for him to successfully insert the tube alone. In fact, if he managed to do so, it would be even more peculiar.

It was only March of his first year, and he was considering intubation. If Dahoon succeeded, rumors would spread that someone more impressive than Suhyuk had arrived.

[Let’s check the vital signs. An Dae-hoon is currently not helpful at all. Even last year, Suhyuk performed better than this.]

‘This?’

[Just ignore it. He learned his tone from you.]

‘Oh.’

Day by day, Suhyuk’s ability to annoy Baruda seemed to be improving. Well, his diagnostic skills were also advancing, though.

In any case, following Baruda’s suggestion, Suhyuk focused on the patient’s vital signs.

‘Blood pressure is 90 over 55… Similar to what I received earlier in the notification.’

[The heart rate is significantly high at 136 beats per minute. It’s too fast.]

In contrast, the body temperature and respiratory rate appeared normal. To some, these might seem like insignificant clues, but for Suhyuk with Baruda’s guidance, they held greater significance.

Baruda could not believe these vital signs, and thus Suhyuk approached the patient once again while memorizing the vital numbers. He held a stethoscope in his hand, aiming to gather more information before conducting an emergency examination.

Breathing… It sounds rough. What do you think it is?

[Analysis in progress.]

How long will it take?

[The analysis has just finished. Based on the 12,752 audio data points acquired by Suhyuk, the patient exhibits a dull sound in the right lower lobe of their lungs, with a 98% likelihood of pulmonary edema as the cause.]

It’s not pneumonia?

[Pneumonia has a possibility of only 0.9%. Considering the normal respiratory rate and body temperature from the vital signs, this can be largely disregarded.]

I see. Yes, based on what I heard, that makes sense.

Medicine requires comprehensive thinking, meaning one should consider all clues rather than focusing solely on one aspect.

It meant that one should consider everything instead of focusing on just one clue. Baruda had developed considerable skills through practice, and Suhyuk reached the same conclusion due to his training.

‘Pulmonary edema. Then what is the cause?’

[Firstly, it does not appear to be from bleeding at the kidney biopsy site.]

‘That makes sense. The wound looks too clean.’

Just in case, Suhyuk lifted the nurse’s hand pressing down on the biopsy area and shook his head. It was indeed pristine. There was only a needle hole with no leakage whatsoever. There wasn’t even any sign of swelling.

‘Furthermore, bleeding alone is unlikely to cause pulmonary edema.’

[Then…] Baruda reminded him of the patient’s heart rate - a staggering 132 beats per minute.

The heart rate was almost twice as fast compared to normal speeds.

His blood flow shouldn’t be reduced due to excessive bleeding, so why is his heart beating so quickly?

[There might be…an issue with the heart itself. I request an electrocardiogram (EKG) test.]

Sounds good.

At that moment, a radiographer entered the hospital room pushing a portable X-ray machine. Normally, this should have been the first examination performed. Regardless of the situation, chest X-rays provide a significant amount of information. However, for Suhyuk and Baruda, it wasn’t necessary at this point. They had already concluded pulmonary edema based solely on their stethoscope, often underestimated by modern doctors.

Moreover, they needed a more urgent test.

“Wait! Just hold on!” Suhyuk stopped the radiographer and tapped the shoulder of the intern nearby.

“Doctor, let’s immediately perform an EKG. It is located at the hospital station nearby, so please bring it quickly.”

“Oh… Yes!”

The intern did not hesitate for long despite the displeased expression of the radiographer. However, the radiographer quietly left without any argument. In contrast, Suhyuk was insistent. Even before considering medical correctness, it would be wise to listen to him.

Wrrr.

Thus, the intern promptly brought the EKG machine through a side passage. Suhyuk, eager and willing, helped attach the leads from the EKG device to the patient’s body. His eyes were fixed on the EKG monitor.

“Darn it.”

As soon as all the leads were connected and a complete electrocardiogram appeared on the monitor, Suhyuk uttered a curse under his breath.

[T waves inverted in V4, 5, and 6.]

Suhyuk immediately understood what Baruda’s words implied.

‘Cardiomyopathy… Could it be a myocardial infarction?’

[There is a possibility of a myocardial infarction, but the probability is low. We need to consider the patient’s age and underlying conditions.]

Due to the urgency of the situation, Baruda refrained from humor and directly offered his opinion. Suhyuk, relying on this input, quickly formulated his own perspective. The focus was intense because they were dealing with the heart, not just any other organ.

‘Underlying conditions…’

[The only condition is lupus. No diabetes or hypertension.

If the patient had been in their forties or suffered from diabetes and high blood pressure, myocardial infarction would undoubtedly have been our primary concern. However, the patient before Suhyuk was merely 23 years old.

He wasn’t obese either. Rather, he appeared quite fit.

“Firstly, get an echocardiogram! Do we have an ultrasound machine nearby? Bring it to this hospital room!”

“Oh yes! Should I bring it over?”

“Yes. Uh…my apologies, Sir! Please wait just a moment.”

“No, no. It’s fine. Thank you.”

Just moments ago, the radiographer had been visibly annoyed. However, after witnessing the abnormal EKG readings, any lingering dissatisfaction vanished instantly.

“We’ll also run blood tests! Start with a full panel! Include CK, CK-MB, Troponin I, and…BNP as well.”

“Yes, Doctor!”

Despite any remaining discontent, there was no atmosphere for expressing grievances amidst the chaotic frenzy reminiscent of a warzone within the treatment room.

The treatment room was chaotic, resembling a warzone. Suhyuk stood amidst this chaos, directing everything with such expertise that it seemed impossible for someone only in their second year as a resident.

Indeed… This person is…

An Dae-hoon watched Suhyuk as if he were witnessing a god.

Meanwhile, the nurse drew some blood, and an intern arrived with an ultrasound machine.

“Yes, Professor. I will perform the initial ultrasound now.”

“Sure! Coming right up!”

“Understood.”

Suhyuk took advantage of a brief pause to end his call with Shin Hyun-tae and picked up the ultrasound device.

The intern immediately squeezed out gel and placed it on the patient’s heart.

Ba-dump.

Ba-dump.

A weak-looking heart was revealed. It wasn’t just my perception; there was something definitely odd about its movement.

‘The overall movement seems diminished.’

[Analysis result: There do not appear to be any significantly impaired areas.]

‘Indeed, this doesn’t match with coronary artery stenosis. Then what is the cardiac output?’

[The CPU equipped in the echocardiogram device is significantly inferior compared to Baruda. We need to wait.]

‘Even in this situation… Ah, damn it.’

The patient’s ejection fraction was 15%. This value clearly indicated heart failure.

It was only because of her youth that she could endure this much; otherwise, she might have already passed away by now.

‘Abnormal EKG, reduced heart movement on ultrasound, and low likelihood of stenosis.’

[There has been no recent trauma to the abdomen, no pheochromocytoma (brown cell tumor), and no cerebral hemorrhage.]

‘Then…’

[Based on the evidence gathered from the treatment room, stress cardiomyopathy can be suspected.]

Baruda provided the most reasonable diagnosis based on the accumulated data. Initially, it determined that the cause of the lowered blood pressure wasn’t due to bleeding from kidney tissue examination but rather from cardiac issues leading to pulmonary edema.

Based on the EKG, underlying disease, and ultrasound findings, it was determined that heart failure wasn’t due to blockages. In conclusion, Baruda diagnosed Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy.

“Damn it.” Suhyuk couldn’t help but curse under these circumstances.

At first glance, stress-induced cardiomyopathy might sound insignificant, but when myocardial function is severely compromised like this case, it significantly increases the risk of death.

“First… Apply a Doppler probe! Transfer immediately to the cardiovascular intensive care unit! Dahoon! Contact the professor! Tell him we’re moving the patient!”

“Yes, yes! B-but what should I say about the diagnosis…?”

“Takotsubo cardiomyopathy with an ejection fraction of 15%. Inform him right away! He’ll rush over instantly!”

“Understood!”

“Okay. Let’s move downstairs first! Have the blood test results come out?” Suhyuk asked while pushing his bed, abandoning his cane.

The interns and nurses were focused on their tasks, but one of them turned towards Suhyuk and shouted:

“Yes! The…other values are fine, but cardiac enzymes including CK are elevated!”

“That is to be expected. What about the rest?”

It made sense due to cardiomyopathy. As heart muscle fibers were destroyed, enzymes would inevitably leak into the bloodstream.

“Oh, liver function tests are back! AST/ALT levels are at 2022, 2617!”

“Ah. This really…”

Decreased heart function was truly frightening. In a healthy adult male, fluid accumulation in the lungs and liver damage could occur rapidly.

The liver was showing signs of necrosis. If this condition persisted, it would lead to multi-organ failure and death.

“[Based on the current situation, I will analyze the optimal treatment method. Conversations may not be possible for some time.]”

Recognizing the severity, Baruda entered analysis mode immediately.

Suhyuk couldn’t even express his gratitude as he pushed the bed forward.

“W-What… What happened?”

Shin Hyun-tae remained silent until they reached halfway through the corridor.

“The patient’s blood pressure dropped… Upon examination, I found pulmonary edema, suspecting cardiac issues. After performing an EKG, there were downsloping ST segments from V4 to V6, leading me to suspect stress-induced cardiomyopathy. The echocardiogram confirmed these findings before we rushed here.”

“Ah.”

Shin Hyun-tae wondered if such a diagnosis was possible for a second-year resident. Lee Hyunjong, who rushed over after hearing Suhyuk’s plea to save him, had similar thoughts.

He is truly unfortunate.

If not for his leg injury, they would have immediately recruited him for cardiology.

Lee Hyunjong finally tore his gaze away from Suhyuk’s legs and faced him directly.

“So what’s your plan? Continue monitoring with the catheter?”

The question wasn’t meant as a test but rather out of genuine curiosity about Suhyuk’s thoughts. Naturally, Suhyuk couldn’t answer right away.

‘Hey, still waiting?’

Bardu remained quiet.

‘Come on.’

“One minute. Just one more minute. You want me to spill everything?”