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1、Case Report1主动脉夹层病例报告英文版Present history : Onset40-year old maleTransient “electric shock like” back and left shoulder painSyncopeLocal hospital 2主动脉夹层病例报告英文版Present history : hospital 1Consciousness recovered (one hour after admission) Paroxysmal dull pain in left shoulder and lower back. 3主动脉夹层病例报告
2、英文版Present history：hospital 1 Neurological Disorders?Neurological examination was normal.Cerebral computed tomography: normalRadiography: hyperosteogeny lumbar hyperosteogeny? Symptoms relieved: dischargedOtherwise Normal4主动脉夹层病例报告英文版Present history：hospital 2Renal Failure? Chest stiffness & breathl
3、essLower limb edema & oliguria Creatinine: 800mmol/LHemodialysis Relieved5主动脉夹层病例报告英文版Present history：hospital 3Cardiomyopathy? Endocarditis？Recurred chest stiffness & breathlessECG: nodal tachycardiaUCG: enlarged heart and aorta, hydropericardium. ？6主动脉夹层病例报告英文版Present history：come to usOn January
4、24th, 2012, the patient came to our hospital. 7主动脉夹层病例报告英文版previous historySmoking and drinking Ceased smoking and abstained from alcoholDenied drug abuseNot aware of any hereditary disease in his family.8主动脉夹层病例报告英文版history：summaryA combination of different clinical findings“Electric shock like” pa
5、in (once)Syncope (once)Chest stiffness & BreathlessRepeated low back painPitting edema of lower extremityMonism9主动脉夹层病例报告英文版Analysis：pluralismAlgia：neurological pain？ Acute coronary syndrome？Syncope：TIA？ Cerebral Infarction？Oliguria & edema：renal failure?Chest stiffness and pain：ACS? PE?Fractured &
6、confused10主动脉夹层病例报告英文版Analysis：monismSudden painLow back painSyncopeChestdiscomfortHydropericardiumRenaldysfunction MI ？ ？ Aortic dissection ？ Endocarditis ？ Cardiomyopathy ？11主动脉夹层病例报告英文版General examination Vital Signs BP: Left, 104/74mmHg; right, 123/77mmHg. water hammer pulse (+)Heart Grade (/6)
7、sighing diastolic murmur at aortic valve area, which radiates toward the apex.12主动脉夹层病例报告英文版General examination AbdomenMild, non-focal abdominal tendernessLower extremitydiminished left lower extremity pulses.13主动脉夹层病例报告英文版LAB FINDINGSBlood routine WBC 4.74G/L; Hb 129g/L Blood biochemistry Na 145mmo
8、l/L, Cl 111 mmol/L,K 4.1mmol/L, Glu 5mmol/L, Urea 5.7mmol/L, Cr 107mol/L, UA 482mol/L; CK 121IU/L, CK-MB 12.4IU/L, LDH-L 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.Otherwise Normal14主动脉夹层病例报告英文版LAB FINDINGSCoagulation funct
9、ion PT=18S, INR=1.5, D-Dimer: 2.4mg/L (2400g/L, normal:500g/L)ESR: 4mm/h. 15主动脉夹层病例报告英文版Imaging findings16主动脉夹层病例报告英文版Imaging findings17主动脉夹层病例报告英文版Imaging findings18主动脉夹层病例报告英文版Imaging findings19主动脉夹层病例报告英文版Imaging findingsCT angiography of chest and abdomen 20主动脉夹层病例报告英文版discussion21主动脉夹层病例报告英文版Di
10、scussion：generalAcute aortic dissection (AAD) Aortic dissection may present with a variety of clinical manifestations22主动脉夹层病例报告英文版Discussion：general75% Misdiagnoses include: myocardial infarction cerebral infarction23主动脉夹层病例报告英文版Discussion：symptoms & signsPainless: 5%Syncope：8% AAD should be consid
11、ered in the differential diagnosis of syncope, even in the absence of pain.24主动脉夹层病例报告英文版DISCUSSION：symptoms & signsAAD may mimic an acute coronary syndrome25主动脉夹层病例报告英文版DISCUSSION：symptoms & signs26主动脉夹层病例报告英文版DISCUSSION：IMAGINGUp to now, various non-invasive and invasive diagnostic steps are requi
12、red to diagnose or to rule-out AAD in case of clinical suspicion. 27主动脉夹层病例报告英文版DISCUSSION：IMAGINGCT and MRI of patients with suspected AAD Sensitivity and specificity of CT： reaching 100%Sensitivity of MRI is up to 95-100%28主动脉夹层病例报告英文版DISCUSSION：imagingUltrasonic cardiograms (UCG)TAS (ultrasound o
13、f the abdomen) TEE (transesophageal echocardiography)29主动脉夹层病例报告英文版DISCUSSION：labDetermination of D-dimerD-Dimer: 2.4mg/L (2400g/L, normal:500g/L)30主动脉夹层病例报告英文版Discussion：TreatmentMedicationMAP 60 to 75 mmHg target HR：around 60bpmBeta blockers and nitroprusside sodiumCalcium channel blockers31主动脉夹层病
14、例报告英文版Discussion：TREATMENTInterventional therapeutic measuresCardiothoracic Surgery32主动脉夹层病例报告英文版DISCUSSION：CLASSIFICATIONS33主动脉夹层病例报告英文版Discussion：PrognosisThe long term follow-upThe mortality rate： 68% 48hrs34主动脉夹层病例报告英文版Discussion：SummaryKey in the management of acute aortic dissection is to maintain a high level of suspicion for this diagnosis.35主动脉夹层病例报告英文版Discussion：SummaryRigorous clinical thinkingPertinent examinationsAvoid stopgap treatment measures36主动脉夹层病例报告英文版Thank you！37主动脉夹层病例报告英文版屏蔽泵配件 仉睿聪奌38主动脉夹层病例报告英文版
