主动脉夹层病例报告英文版.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,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,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.,？,？,？,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 107,mol/L,UA 482,mol/L;CK 121IU/L,CK-MB 12.4IU/L,LDH-L 198 IU/L;AMY33 IU/L,LPS 57 IU/L,AFP4.8,g/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(,2400,g/L,normal:500,g/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 to maintain a,high level of suspicion,for this diagnosis.,Discussion,：,Summary,Rigorous clinical thinking,Pertinent examinations,Avoid stopgap treatment measures,Thank you,！,屏蔽泵配件 仉睿聪奌,