主动脉夹层病例报告英文版课件.pptxVIP

Presenthistory:Onset

·40-yearoldmale

·Transientelectricshocklikebackandleftshoulderpain

·Syncope

·Localhospital

1

Presenthistory:hospital1

·Consciousnessrecovered

(onehourafteradmission)

·Paroxysmaldullpaininleftshoulderand

lowerback.

Presenthistory:hospital1

Neurologica/Dio

-NeurologicalexaMationwasnormal.·Cerebrakputedtomography.normal

otngaphyhyperosteogeny

lumbarhyperosteogeny?

·Symptomsrelieved:discharged

3

Presenthistory:hospital2

RenalFailure?

·Cheststiffnessbreathless

·Lowerlimbedemaoliguria·Creatinine:800mmol/L

·Hemodialysis

·Relieved

4

Cardiomyopathy?Endocarditis?

·Recurredcheststiffnessbreathless

·ECG:nodaltachycardia

·UCG:enlargedheartandaorta,hydropericardium.

Presenthistory:hospital3

Presenthistory:cometous

·OnJanuary24th,2019,thepatientcame

toourhospital.

6

·Ceasedsmokingandabstainedfromalcohol·Denieddrugabuse

·Notawareofanyhereditarydiseaseinhisfamily.

previoushistory

·Smokinganddrinking

history:summary

Acombinationofdifferentclinicalfindings

·Electricshocklikepain(once)

·Syncope(once)

·CheststiffnessBreathless

·Repeatedlowbackpain

·Pittingedemaoflowerextremity

Monism

8

Syccoop3Seorallniarction?

se

pea

e:TI

Analysis:nluralism

Analysis:monism

Generalexamination

·VitalSigns

BP:Left,104/74mmHg;right,123/77mmHg.

waterhammerpulse(+)

·Heart

Grade(IV/6)sighingdiastolicmurmurataortic

valvearea,whichradiatestowardtheapex.

11

Mild,non-focalabdominaltenderness

·Lowerextremity

diminishedleftlowerextremitypulses.

Generalexamination

·Abdomen

12

Na145mmol/L,CI111nLX4.1mmol/L,Glu

5mmol/L,Urea5.7mmc107μmol/L,UA482μmol/L;

CK1211U/L,CK-241U/L,LDH-L198IU/L;AMY33

IU/L,LPS

·Thyroidfunction

T3=1.44nmol/L,T4=102nmol/L,fT3=4.23pmol/L,

ISHE3.75m²4=

LABF