教育主动脉夹层病例报告英文版英语.ppt

Present history : Onset,40-year old male Transient “electric shock like” back and left shoulder pain Syncope Local hospital,Present history : hospital 1,Consciousness recovered (one hour after admission) Paroxysmal dull pain in left shoulder and lower back.,Present history：hospital 1,Neurological Disorders? Neurological examination was normal. Cerebral computed tomography: normal Radiography: hyperosteogeny lumbar hyperosteogeny? Symptoms relieved: discharged,Otherwise Normal,Present history：hospital 2,Renal Failure? Chest stiffness & breathless Lower limb edema & oliguria Creatinine: 800mmol/L Hemodialysis Relieved,Present history：hospital 3,Cardiomyopathy? Endocarditis？ Recurred chest stiffness & breathless ECG: nodal tachycardia UCG: enlarged heart and aorta, hydropericardium.,？,？,？,Present history：come 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.,history：summary,A combination of different clinical findings “Electric shock like” pain (once) Syncope (once) Chest stiffness & Breathless Repeated low back pain Pitting edema of lower extremity,Monism,Analysis：pluralism,Algia：neurological pain？ Acute coronary syndrome？ Syncope：TIA？ Cerebral Infarction？ Oliguria & edema：renal failure? Chest stiffness and pain：ACS? PE?,Fractured & confused,Analysis：monism,？,General examination,Vital Signs BP: Left, 104/74mmHg; right, 123/77mmHg. water hammer pulse (+) Heart Grade (/6) sighing diastolic murmur at aortic valve area, which radiates toward the apex.,General examination,Abdomen Mild, non-focal abdominal tenderness Lower extremity diminished left lower extremity pulses.,LAB FINDINGS,Blood 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 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 Normal,LAB FINDINGS,Coagulation function PT=18S, INR=1.5, D-Dimer: 2.4mg/L (2400g/L, normal:500g/L) ESR: 4mm/h.,Imaging findings,Imaging findings,Imaging findings,Imaging findings,Imaging findings,CT angiography of chest and abdomen,discussion,Discussion：general,Acute aortic dissection (AAD) Aortic dissection may present with a variety of clinical manifestations,Discussion：general,75% Misdiagnoses include: myocardial infarction cerebral infarction,Discussion：symptoms & signs,Painless: 5% Syncope：8% AAD should be considered in the differential diagnosis of syncope, even in the absence of pain.,DISCUSSION：symptoms & signs,AAD may mimic an acute coronary syndrome,DISCUSSION：symptoms & signs,DISCUSSION：IMAGING,Up to now, various non-invasive and invasive diagnostic steps are required to diagnose or to rule-out AAD in case of clinical suspicion.,DISCUSSION：IMAGING,CT and MRI of patients with suspected AAD Sensitivity and specificity of CT： reaching 100% Sensitivity of MRI is up to 95-100%,DISCUSSION：imaging,Ultrasonic cardiograms (UCG) TAS (ultrasound of the abdomen) TEE (transesophageal echocardiography),DISCUSSION：lab,Determination of D-dimer D-Dimer: 2.4mg/L (2400g/L, normal:500g/L),Discussion：Treatment,Medication MAP 60 to 75 mmHg target HR：around 60bpm Beta blockers and nitroprusside sodium Calcium channel blockers,Discussion：TREATMENT,Interventional therapeutic measures Cardiothoracic Surgery,DISCUSSION：CLASSIFICATIONS,Discussion：Prognosis,The long term follow-up The mortality rate： 68% 48hrs,Discussion：Summary,Key in the management of acute aortic dissection is