Chest pain as if tearing the heart and lungs and pain to the back, and cold sweat, it may be aortic dissection; the picture is a situational photo, and the people in the picture have nothing to do with this article;

(picture taken from: shutterstock)

Text / Lin Weiwen

A male patient in his 50s with high blood pressure and long-term smoking was rushed to the hospital for emergency treatment because he suddenly had heart-piercing chest pain and the pain shifted to his back pain and cold sweat.

In the emergency department, it was found that his blood pressure was as high as 210/100 mmHg, and the electrocardiogram showed inferior wall myocardial infarction.

However, his blood pressure in all four limbs was different. The blood pressure difference between the left hand and the right hand was 60 mm Hg. After tomographic scanning aorta angiography, it was found that both the ascending and descending aorta were dissected. The phenomenon of myocardial infarction due to opening.

Such severe aortic dissection was very critical, and the patient was saved after the cardiac surgeon arranged for aortic replacement surgery!

Please read on...

Figure 1: Computed tomography scan shows that the patient's aorta is dissected, and the endothelium at the dissected part is in the lumen of the vessel (arrow).

(Photo courtesy/Lin Weiwen)

High blood pressure is the most common cause

Aortic dissection is the tearing between the endothelium and the media of the aorta due to high blood pressure or strong external force.

On the image, you can see that the endothelium is floating in the blood vessel like a torn wallpaper (Figure 1), and at the same time it will cause blood to fill in between the two layers to form a false lumen.

When the tear continues, or the false cavity formed becomes larger and larger, it may cause compression, affect the circulation of vascular collaterals, and cause organ ischemia, hypoxia, and even severe necrosis!

Generally, aortic dissection occurs in middle-aged and elderly people, chronic diseases with three high levels, or congenital genetic diseases, such as Marfan syndrome, polycystic kidney disease, etc.

Due to congenital or acquired diseases, the structure of the aorta is relatively loose. At this time, when the endothelial layer of the aorta has a defect or crack, and the blood pressure fluctuates greatly at this time, the blood enters the crack like a planer, and the entire intima is torn off. Or form a false cavity.

High blood pressure is the most common cause of disease, especially when the weather suddenly becomes cold or the pressure is too high, the work and rest are not normal, and the blood pressure fluctuates greatly, and the blood pressure suddenly rises, and aortic dissection is prone to occur!

Figure 2: Aortic dissection is divided into type A and type B. The part indicated by the blue arrow is the dissection position, type A is dissection of the ascending aorta, and type B is dissection of the descending aorta.

(Photo courtesy/Lin Weiwen)

Generally, aortic dissection is divided into type A and type B aortic dissection (Figure 2), type A includes ascending aortic dissection, and type B is pure descending aortic dissection.

Usually type A is more dangerous and requires immediate surgical treatment; if the type B is simply dissection of the descending aorta, basically, if the vital signs are stable and no serious false lumen is formed to compress the collateral circulation of other organs, medical methods can be used Treatment, that is, drugs to control blood pressure and heartbeat.

For example, this male patient suffered from myocardial infarction due to type A aortic dissection causing obstruction of the right coronary artery ostium, so surgical treatment was required; if the dissection was to the heart, it would cause pericardial tamponade and cardiogenic shock, and even affect the Acute prolapse and reflux caused by the function of the aortic valve also require surgical treatment.

Generally speaking, aortic dissection is manifested as chest pain. Usually, patients report pain from the front chest to the back, and the most common tear-like pain is continuous.

If the aortic dissection is performed in the direction of the abdominal aorta, it will cause chest pain to the abdomen.

The examination of aortic dissection can be done by taking X-rays to see if the chest septum is enlarged, measuring whether there is any significant difference in blood pressure in the extremities, and finally doing a tomographic aortic angiography to confirm whether aortic dissection and the formation of a false lumen can be seen. diagnosis.

Control blood pressure and avoid fatigue

The best way to prevent aortic dissection is to control blood pressure, avoid overwork and excessive pressure, try to avoid going out when the weather turns cold, and take measures to keep warm.

Patients in the high-risk group should follow the doctor's advice. Patients with the "three highs" should take medicine and return to the clinic regularly. In particular, blood pressure must be well controlled, avoid mood swings, relieve stress appropriately, and moderate exercise to relieve tension. Controlling emotional fluctuations can help prevent aortic dissection.

(The author is the Director of the Department of Cardiology and the Director of the Cardiac Catheterization Department, Tai Adventist Hospital)

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  • myocardial infarction

  • three high

  • hypertension

  • aortic dissection

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