Health Worlds

Department of Cardiology, aortic dissection is one of acute critical illness in recent years, the incidence on the rise. The sudden onset, high mortality, large differences in clinical manifestations, often related to problems between families, very easy to misdiagnosis and missed diagnosis.
1 Clinical data
Male patient, 33 years old, married, Han. Due to activity in patients with sudden knife-like chest pain for one hour after admission, the pain radiation to back, with heart palpitations, breathing difficulties, not accompanied by cough, hemoptysis, and not accompanied by syncope, outside hospital diagnosis of "myocardial infarction", given nitroglycerin and other treatment, no significant improvement was transferred to our hospital, clinic to "acute coronary syndrome" close the hospital. Past the age of one line in the left lower quadrant patients with hernia surgery;-year-old outside the hospital had a diagnosis of nephritis (specifically unknown), oral administration of traditional Chinese medicine, not re. Admission examination: T36.7 P68 / min R 20 min BP180/100mmHg normal development, good nutrition, acute pain sickly, conscious, into the room, automatic positioning, inspection cooperation, both sides of the pupil and other large and round, on the existence of light reflection, pharynx not congestion, neck soft breath sounds clear lungs, no rales heard and dry sex, heart sounds strong, heart rate 68 beats / min, the law of Qi, the valve auscultation area a


nd the noise is not heard. Abdomen soft, no tenderness and rebound tenderness, liver and spleen ribs no time, the negative symptoms of liver neck, and blood vessels did not hear noise, no lower extremity edema. Limb muscle tone can be, there is physiological reflex, pathological reflex was not elicited. Patient information: the outer ECG: sinus rhythm, ST-T changes. Admission electrocardiogram showed Charles V1, V2 lead slightly elevated ST segment, , , aVL, V5, V6 leads ST segment depression, , aVL, V5, V6 leads T wave inversion, but no pathological Q wave . Hospital admission for acute coronary syndrome-related therapy (low molecular weight heparin, nitroglycerin, aspirin, simvastatin, metoprolol, etc.). Poor relief in patients with chest pain, myocardial enzymes and ECG repeated investigations no significant dynamic change, then admitted to hospital the next day the magnetic resonance imaging of aortic dissection prompted separation (from the aortic arch to the abdominal aorta), cardiac ultrasound examinations showed hypertrophic heart disease (ventricular septal thickness 19mm). Adjust the treatment immediately after diagnosis (disabled low molecular weight heparin and aspirin, to strengthen control of blood pressure and heart rate), after active treatment, patient's condition gradually improved, was discharged in stable condition after a half months, to higher hospital plant aortic stent into operation. Jingmen City Second People's Hospital Department of Cardiology, Li YongshengForeign reports, 10-20 the incidence of aortic dissection / 1 100 million people, there is no domestic incidence statistics in the sample. In the Chinese population the incidence of hypertrophic cardiomyopathy is about 0.16%, the total number of patients was estimated at 100 million 2. Both the incidence is rare, the particularity of the patient's condition led to the misdiagnosis of admission, but patients without myocardial enzymes and ECG after admission dynamics, further action should be timely and relevant examination. Aortic dissection is now one of the highest mortality of cardiovascular disease, according to statistics, the patients without treatment within 2 days after onset of disease in 7% -50% each, 1 week case fatality rate was 60% -70% 3. Early diagnosis of aortic dissection, prompt treatment is the key to reducing mortality. Aortic dissection because of the performance of different parts of different tear, often misdiagnosed as coronary heart disease, pericarditis, acute abdomen, such as cerebral vascular accident. 4 temporary safety bolt 36 cases were misdiagnosed aortic dissection analysis of 11 cases (30.6%), chest pain accompanied by ST-T changes were misdiagnosed as acute coronary syndrome. Wang Shuiyun 5 53 patients with aortic dissection and other diagnosis and misdiagnosis of patients, 12 patients (22.6%) chest pain patients with ST-T abnormalities were misdiagnosed as acute coronary syndrome. For the combined ECG ST-T changes in patients with aortic dissection easily misdiagnosed as coronary heart disease, this treatment will lead to misdiagnosis errors in principle, that the use of anticoagulation, antiplatelet or thrombolytic agents, which will increase patient mortality. To reduce the misdiagnosis of these patients, we should raise awareness of aortic dissection. For all patients with severe chest pain, should be alert to the possibility of aortic dissection. For the combined ST-T changes in patients, should be repeatedly asked the painful area, nature and associated symptoms, and careful examination to understand whether the marfans syndrome signs; close observation of ECG and myocardial enzyme changes in the short term (15 to 30 minutes ) No change should be a positive line of ECG-related checks to clear for aortic dissection; active myocardial ischemia by anti-poor treatment of aortic dissection should be considered possible. Once the diagnosis of aortic dissection, should be actively controlling blood pressure and heart rate.1 Tan Kok Wai, Cheng Tsung-E. Within the heart of modern science M. 1st edition. Changsha: Hunan Science and Technology Press ,1999:1187-1194
2 Zou Y, Song L, Wang Z, et al.Prevalen of idiopathic hypertrophic cardiomyopathy in China: a population-based echocardiographic analysis of 8080 adults [J]. Am J Med ,2004,
3 Dongcheng Liang, Tao Shouqi, Chen Hao Zhu, et al. Practical Cardiology M. 3rd ed. Shanghai: Shanghai Science and Technology Press ,1993:870-880
4 seek security bolt, Mengxue Gang, Xu Wenyi. Misdiagnosis of Aortic Dissection J. Clinical misdiagnosis and mistreatment, 2002,15 (4): 271
5 Wang Ectocarpus, Marun Fen, Huang Zhijun. Aortic dissection the emergency diagnosis and misdiagnosis J. Journal of Emergency Medicine, 2003,12 (9) :619-21



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