1、主动脉夹层病例报告英文Present history:hospital 1 Consciousness recovered (one hour after admission)Paroxysmal dull pain in left shoulder and lower back.Present historyhospital 1 Neurological Disorders?Neurological examination was normal.Cerebral computed tomography:normalRadiography:hyperosteogeny lumbar hyper
2、osteogeny?Symptoms relieved:dischargedPresent historyhospital 2Renal Failure?Chest stiffness&breathlessLower limb edema&oliguria Creatinine:800mmol/LHemodialysis RelievedPresent historyhospital 3Cardiomyopathy?Endocarditis？Recurred chest stiffness&breathlessECG:nodal tachycardiaUCG:enlarged heart an
3、d aorta,hydropericardium.Present historycome to us On January 24th,2012,the patient came to our hospital.previous history Smoking and drinking Ceased smoking and abstained from alcohol Denied drug abuse Not aware of any hereditary disease in his family.historysummaryA combination of different clinic
4、al findings“Electric shock like”pain(once)Syncope(once)Chest stiffness&BreathlessRepeated low back painPitting edema of lower extremityMonism主动脉夹层病例报告英文DISCUSSIONIMAGING4mg/L(2400g/L,normal:500g/L)ECG:nodal tachycardiaGeneral examinationThyroid functionFractured&confusedConsciousness recoveredCT and
5、 MRI of patients with suspected AADLower extremityCT angiography of chest and abdomenSensitivity and specificity of CT reaching 100%A combination of different clinical findingsDiscussionSummaryNa 145mmol/L,Cl 111 mmol/L,K 4.Pitting edema of lower extremityBP:Left,104/74mmHg;DiscussionTreatmentAnalys
6、ispluralism Algianeurological pain？Acute coronary syndrome？SyncopeTIA？Cerebral Infarction？Oliguria&edemarenal failure?Chest stiffness and painACS?PE?AnalysismonismGeneral examination Vital Signs BP:Left,104/74mmHg;right,123/77mmHg.water hammer pulse(+)Heart Grade(/6)sighing diastolic murmur at aorti
7、c valve area,which radiates toward the apex.General examination AbdomenMild,nonfocal abdominal tendernessLower extremitydiminished left lower extremity pulses.LAB FINDINGSBlood routine WBC 4.74G/L;Hb 129g/L Blood biochemistry Na 145mmol/L,Cl 111 mmol/L,K 4.1mmol/L,Glu 5mmol/L,Urea 5.7mmol/L,Cr 107mo
8、l/L,UA 482mol/L;CK 121IU/L,CKMB 12.4IU/L,LDHL 198 IU/L;AMY33 IU/L,LPS 57 IU/L,AFP4.8g/L;Thyroid function T3=1.44nmol/L，T4=102nmol/L，fT3=4.23pmol/L,TSH=3.75mIU/L.LAB FINDINGSCoagulation function PT=18S,INR=1.5,D-Dimer:2.4mg/L(2400g/L,normal:500g/L)ESR:4mm/h.Imaging findingsImaging findingsESR:4mm/h.4
9、mg/L(2400g/L,normal:500g/L)Thyroid functionAcute aortic dissection(AAD)LAB FINDINGSHemodialysisNa 145mmol/L,Cl 111 mmol/L,K 4.UCG:enlarged heart and aorta,hydropericardium.Blood biochemistryMAP 60 to 75 mmHgKey in the management of acute aortic dissection is to maintain a high level of suspicion for
10、 this diagnosis.DISCUSSIONIMAGINGDiscussiongeneralBlood routineNa 145mmol/L,Cl 111 mmol/L,K 4.Up to now,various noninvasive and invasive diagnostic steps are required to diagnose or to ruleout AAD in case of clinical suspicion.myocardial infarctionSmoking and drinkingGeneral examinationImaging findi
11、ngsImaging findingsImaging findingsImaging findingsCT angiography of chest and abdomen discussionDiscussiongeneral Acute aortic dissection(AAD)Aortic dissection may present with a variety of clinical manifestationsDiscussiongeneral75%Misdiagnoses include:myocardial infarction cerebral infarctionDisc
12、ussionsymptoms&signs Painless:5%Syncope8%AAD should be considered in the differential diagnosis of syncope,even in the absence of pain.DISCUSSIONsymptoms&signs AAD may mimic an acute coronary syndromeDISCUSSIONsymptoms&signsDISCUSSIONIMAGING Up to now,various noninvasive and invasive diagnostic step
13、s are required to diagnose or to ruleout AAD in case of clinical suspicion.DISCUSSIONIMAGING CT and MRI of patients with suspected AAD Sensitivity and specificity of CT reaching 100%Sensitivity of MRI is up to 95100%DISCUSSIONimaging Ultrasonic cardiograms(UCG)TAS(ultrasound of the abdomen)TEE(trans
14、esophageal echocardiography)Pertinent examinationsmyocardial infarctionDiscussiongeneralSyncope(once)1mmol/L,Glu 5mmol/L,Urea 5.LAB FINDINGShistorysummaryDISCUSSIONsymptoms&signsmyocardial infarctionNa 145mmol/L,Cl 111 mmol/L,K 4.Thyroid functionAlgianeurological pain？Acute coronary syndrome？DISCUSS
15、IONIMAGINGImaging findingsOtherwise NormalNa 145mmol/L,Cl 111 mmol/L,K 4.Fractured&confusedOtherwise NormalRenal Failure?Pertinent examinationsESR:4mm/h.DISCUSSIONlab Determination of Ddimer DDimer:2.4mg/L(2400g/L,normal:500g/L)DiscussionTreatmentMedicationMAP 60 to 75 mmHg target HRaround 60bpmBeta
16、 blockers and nitroprusside sodiumCalcium channel blockersDiscussionTREATMENT Interventional therapeutic measures Cardiothoracic SurgeryDISCUSSIONCLASSIFICATIONSDiscussionPrognosis The long term followup The mortality rate 68%48hrsDiscussionSummary Key in the management of acute aortic dissection is
17、 to maintain a high level of suspicion for this diagnosis.DiscussionSummary Rigorous clinical thinking Pertinent examinations Avoid stopgap treatment measuresAcute aortic dissection(AAD)right,123/77mmHg.Calcium channel blockersmyocardial infarctionNa 145mmol/L,Cl 111 mmol/L,K 4.7mmol/L,Cr 107mol/L,U
18、A 482mol/L;CK 121IU/L,CKMB 12.4IU/L,LDHL 198 IU/L;AMY33 IU/L,LPS 57 IU/L,AFP4.Fractured&confusedRenal Failure?LAB FINDINGSDetermination of DdimerPitting edema of lower extremityDISCUSSIONsymptoms&signsBlood biochemistryDiscussiongeneralAnalysismonismOtherwise NormalRadiography:hyperosteogenyThank you！
