主动脉夹层病例报告英文版参考PPT

1、Case Report,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,Neur

2、ological 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 right, 123/77mmHg. water hammer pulse (+) Heart Gr

3、ade (/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 mmo

4、l/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-Dime

5、r: 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,

6、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 syndro

7、me,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% Sens

8、itivity 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 60b

9、pm 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 to maintain a high level of suspicion for th