Chest tightness and high blood pressure refused to perform chest CT scan. The emergency doctor discovered "aortic dissection" and denounced it as a completely abnormal condition.
With chest tightness and high blood pressure, he shouted, “Just take the medicine and you’ll be fine.” The emergency doctor discovered aortic dissection.
Don’t think that chest tightness and high blood pressure are just trivial matters; they may be signs of a surgical emergency called aortic dissection. Dr. Bai Yongjia, director of the Department of Emergency Medicine at Hsinchu MacKay Memorial Hospital, issued a document stating that when a middle-aged man was sent to the emergency room, although he only had symptoms of chest tightness and high blood pressure, and the current electrocardiogram showed no abnormalities, it was still recommended to undergo further examination. Unexpectedly, the man believed that he was fine and insisted on being discharged from the hospital. He even told the medical staff, “Just give me the medicine and I’ll take it when I go home.”
“The patient is not an elderly person, but he is completely unconcerned and ignores the risk of aortic dissection!” Dr. Bai Yongjia said that only a complete examination can rule out the possibility of aortic dissection. He had to persuade the patient repeatedly and even reprimanded him before the patient finally agreed to undergo chest surgery. Computer tomography and other related examinations revealed aortic dissection, and emergency intervention was arranged to save the patient’s precious life.
Chest pain, back pain, cold sweat, don’t ignore aortic dissection, the mortality rate within 48 hours is nearly 50%
Aortic dissection is a rare surgical emergency with a high fatality rate. The aortic blood vessel is divided into three layers: inner, middle and outer layers. When the inner layer ruptures, blood flow will enter between the intima and the middle layer to form a “false lumen”, resulting in aortic The artery is stripped into two chambers. When the blood breaks out of the false chamber, the aorta will bleed massively and cause sudden death. Aortic dissection is usually divided into two types: A and B. Type A aortic dissection occurs in the “ascending aorta”, while type B aortic dissection occurs in the aorta other than the “ascending aorta”.
Aortic dissection most commonly occurs between the ages of 40 and 70, with a prevalence rate of approximately 5-30 per million. If acute type A aortic dissection is not treated promptly at the time of onset, about 50% of patients will die within 48 hours, and the mortality rate will increase by 1-2% every hour on average. Symptoms of aortic dissection include severe chest pain, back pain, abdominal pain, and cold sweats. Other symptoms include shortness of breath, weakness in hands and feet, shock coma, or cardiovascular complications such as foot ischemia, paralysis, acute myocardial infarction, and stroke. wait.
Nearly 80% of patients with aortic dissection have a history of hypertension and should still control their blood pressure for a long time after treatment.
According to statistics from the International Registry of Acute Aortic Dissection (IRAD), long-term uncontrolled hypertension is the most important causative factor of aortic dissection. Some studies indicate that 75-80% of patients with aortic dissection have a history of hypertension, and hypertension is also related to atherosclerosis of the aorta, which leads to fibrosis of the aortic wall and thickening of the intima, which makes it fragile. Other congenital and acquired risk factors include: vascular disease, terminal tissue disease (such as Marfan syndrome), inherited vascular disease (such as bivalve aortic valve), vasculitis, trauma, and previous aortic surgery. Surgery, smoking, dyslipidemia, etc.
Recent studies have pointed out that there is an important correlation between genetic inheritance and aortic dissection, including Marfan syndrome, bivalve aortic valve, Ehlers-Danlos syndrome, LD syndrome, familial aortic dissection or dissection, etc., as long as there are related Family history should include aggressive blood pressure control and regular follow-up. In addition, whether it is type A or type B aortic dissection, aortic aneurysm may form in the long term, and subsequent surgical treatment is required if necessary.
Since the aorta has a high fatality rate and can cause serious complications, when further examination and treatment are required based on clinical manifestations and imaging evaluation by the physician, the patient should cooperate with the physician to receive a detailed diagnosis. Once aortic dissection is confirmed, not only Early drug or surgical treatment is required, and subsequent blood pressure must be properly controlled below 135/85 mmHg. For those with Marfan syndrome, it is recommended to control blood pressure below 130/80 mmHg to ensure life safety.
Data source:
Zheng Quanhao, Lin Yiqing: Diagnosis and treatment of aortic dissection
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