教育主動(dòng)脈夾層病例報(bào)告英文版英語(yǔ)

1、Present history : Onset,40-year old maleTransient “electric shock like” back and left shoulder painSyncopeLocal hospital,Present history : hospital 1,Consciousness recovered (one hour after admission) Paroxysmal

2、dull pain in left shoulder and lower back.,Present history：hospital 1,Neurological Disorders?Neurological examination was normal.Cerebral computed tomography: normalRadiography: hyperosteogeny lumbar hyperosteogeny?

3、 Symptoms relieved: discharged,Otherwise Normal,Present history：hospital 2,Renal Failure? Chest stiffness & breathlessLower limb edema & oliguria Creatinine: 800mmol/LHemodialysis Relieved,Present history：h

4、ospital 3,Cardiomyopathy? Endocarditis？Recurred chest stiffness & breathlessECG: nodal tachycardiaUCG: enlarged heart and aorta, hydropericardium.,？,？,？,Present history：come to us,On January 24th, 2012, the patien

5、t came to our hospital.,previous history,Smoking and drinking Ceased smoking and abstained from alcoholDenied drug abuseNot aware of any hereditary disease in his family.,history：summary,A combination of different cli

6、nical findings“Electric shock like” pain (once)Syncope (once)Chest stiffness & BreathlessRepeated low back painPitting edema of lower extremity,Monism,Analysis：pluralism,Algia：neurological pain？ Acute coronary s

7、yndrome？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;

8、 right, 123/77mmHg. water hammer pulse (+)Heart Grade (Ⅳ/6) sighing diastolic murmur at aortic valve area, which radiates toward the apex.,General examination,AbdomenMild, non-focal abdominal tenderness

9、Lower extremitydiminished 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 107μmol/L, UA

10、 482μmol/L; CK 121IU/L, CK-MB 12.4IU/L, LDH-L 198 IU/L; AMY33 IU/L, LPS 57 IU/L, AFP4.8μg/L; Thyroid function T3=1.44nmol/L，T4=102nmol/L，fT3=4.23pmol/L, TSH=3.75mIU/L.,Otherwise Normal,LAB FINDINGS,Coagulation funct

11、ion PT=18S, INR=1.5, D-Dimer: 2.4mg/L (2400µg/L, normal:<500µg/L)ESR: 4mm/h.,Imaging findings,Imaging findings,Imaging findings,,Imaging findings,,Imaging findings,CT angiography of chest and abdome

12、n,,,,discussion,Discussion：general,,Acute aortic dissection (AAD) Aortic dissection may present with a variety of clinical manifestations,Discussion：general,75% ×Misdiagnoses include: myocardial infarction cere

13、bral 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 a

14、cute 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.,DISCUSSI

15、ON：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)

16、TEE (transesophageal echocardiography),DISCUSSION：lab,Determination of D-dimerD-Dimer: 2.4mg/L (2400µg/L, normal:<500µg/L),Discussion：Treatment,MedicationMAP 60 to 75 mmHg target HR：around 60bpmBeta bloc

17、kers and nitroprusside sodiumCalcium channel blockers,Discussion：TREATMENT,Interventional therapeutic measuresCardiothoracic Surgery,DISCUSSION：CLASSIFICATIONS,Discussion：Prognosis,The long term follow-upThe mortalit

18、y 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 thinkingPertinent examinationsAvoi