主动脉夹层病例报告英文版参考PPT

1、case reportpresent 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: normalradiography: hyperosteogeny lumbar hyperosteogeny? symptoms relieved: dischargedpresent history：hospital 2renal failure? chest stiffness & breathlesslower limb edema & oliguria creatinine: 800mmol/lhem

3、odialysis relievedpresent history：hospital 3cardiomyopathy? endocarditis？recurred chest stiffness & breathlessecg: nodal tachycardiaucg: enlarged heart and aorta, hydropericardium. present history：come to us on january 24th, 2012, the patient came to our hospital. previous history smoking and dr

4、inking ceased smoking and abstained from alcohol denied drug abuse not aware of any hereditary disease in his family.history：summarya combination of different clinical findings“electric shock like” pain (once)syncope (once)chest stiffness & breathlessrepeated low back painpitting edema of lower

5、extremitymonismanalysis：pluralism algia：neurological pain？ acute coronary syndrome？ syncope：tia？ cerebral infarction？ oliguria & edema：renal failure? chest stiffness and pain：acs? pe?analysis：monismgeneral examination vital signs bp: left, 104/74mmhg; right, 123/77mmhg. water hammer pulse (+)hea

6、rt grade (/6) sighing diastolic murmur at aortic valve area, which radiates toward the apex.general examination abdomenmild, non-focal abdominal tendernesslower extremitydiminished left lower extremity pulses.lab findingsblood routine wbc 4.74g/l; hb 129g/l blood biochemistry na 145mmol/l, cl 111 mm

7、ol/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.lab findingscoagulation function pt=18s, inr=1.5, d-dimer: 2.4mg/l (2400g

8、/l, normal:500g/l)esr: 4mm/h. imaging findingsimaging findingsimaging findingsimaging findingsimaging findingsct angiography of chest and abdomen discussiondiscussion：general acute aortic dissection (aad) aortic dissection may present with a variety of clinical manifestationsdiscussion：general75% mi

9、sdiagnoses include: myocardial infarction cerebral infarctiondiscussion：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 syndromediscussion：sympt

10、oms & signsdiscussion：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

11、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：treatmentmedicationmap 60 to 75 mmhg target hr：around 60bpmbeta blockers and nitroprusside sodiumcalcium channel blockersdiscussion：treatment interventional therapeutic measures cardiothoracic surgerydiscussion：classificationsdiscussion：prognosis the long term follow-up the mortality rate： 68% 48hrsdiscussion：summary key in the management of acute aortic dissection i