Lionakis Nikolaos, Moyssakis Ioannis, Gialafos Elias, Dalianis Nikolaos, Votteas Vassilios
Cardiology Department, Laiko General Hospital, Athens, Greece.
J Clin Hypertens (Greenwich). 2008 Jan;10(1):69-72. doi: 10.1111/j.1524-6175.2007.07202.x.
A 55-year-old man with a history of uncontrolled hypertension was admitted because of an episode of severely elevated blood pressure. An electrocardiogram revealed complete atrioventricular block while imaging showed a dissecting aneurysm of the descending thoracic and abdominal aorta, type B according to the Stanford classification. Laboratory tests revealed significant increases in serum C-reactive protein. Coronary arteriography was performed and was negative for coronary artery disease. A VDD pacemaker was placed, and a combination of 4 antihypertensive agents was used as treatment. Type B aortic dissection may present with a wide range of manifestations. The authors suggest that measurement of C-reactive protein may be used in hypertensive patients to help reflect vascular injury and its degree, progression, and prognosis. Disorders of intraventricular conductivity are rarely seen in both types of dissection of the aorta (type A, B). Atrioventricular conductivity disorders that result in complete atrioventricular block have been reported only in patients with type A dissection (before the bifurcation of the subclavian artery). In this particular case, however, the authors diagnosed an atrioventricular conductivity disorder causing atrioventricular block in a patient with type B dissection. Consequently, the authors speculate that myocardial fibrosis, as a result of long-standing hypertension, could be the main pathogenetic mechanism leading to the development of such phenomena, resulting from a potential expanding of the fibrotic process to the atrioventricular conduction system.
一名55岁有高血压控制不佳病史的男性因一次严重血压升高发作入院。心电图显示完全性房室传导阻滞，而影像学检查显示降主动脉和腹主动脉夹层动脉瘤，根据斯坦福分类为B型。实验室检查显示血清C反应蛋白显著升高。进行了冠状动脉造影，结果显示冠状动脉疾病阴性。植入了VDD起搏器，并使用4种抗高血压药物联合治疗。B型主动脉夹层可能有多种表现。作者建议，在高血压患者中测量C反应蛋白可能有助于反映血管损伤及其程度、进展和预后。主动脉夹层的两种类型（A型、B型）很少见到室内传导障碍。导致完全性房室传导阻滞的房室传导障碍仅在A型夹层患者（锁骨下动脉分叉前）中报道过。然而，在这个特殊病例中，作者诊断出一名B型夹层患者存在导致房室传导阻滞的房室传导障碍。因此，作者推测，长期高血压导致的心肌纤维化可能是导致这种现象发生的主要发病机制，这是由于纤维化过程可能扩展到房室传导系统所致。
