Silbernagel Günther, Brechtel Klaus, Stock Jan, Randrianarisoa Elko, Schneider Wilke, Ziemer Gerhard, Häring Hans-Ulrich, Balletshofer Bernd
Medizinische Universitätsklinik Tübingen, Abteilung für Endokrinologie, Diabetologie, Nephrologie, Angiologie und Klinische Chemie.
Dtsch Med Wochenschr. 2010 Mar;135(9):394. doi: 10.1055/s-0030-1247610. Epub 2010 Feb 23.
We report on a patient with known hypertension, who presented to his general practitioner with severe thoracic pain of sudden onset. The aches had started during a dental treatment. Immediately, the patient was admitted to hospital by the general practitioner because myocardial ischemia was suspected.
Neither the electrocardiogram nor the laboratory findings (creatin kinase, troponin I) argued for an acute coronary syndrome. Since the plasma D-dimer level was increased and the transthoracic echocardiography showed discrete signs of right ventricular strain, pulmonary embolism could not be ruled out. Because of the high intensity of pain and for further diagnostics the patient underwent a contrast medium-enhanced computed tomography (CT).
DIAGNOSIS, TREATMENT AND COURSE: The contrast medium-enhanced CT showed a type B acute aortic dissection. According to the current guidelines for the treatment of type B aortic dissection, a conservative therapeutic regimen was applied. Antihypertensive therapy was escalated. Furthermore, the patient transiently received analgesic drugs. After three weeks the patient was released from hospital without pain and with physiologic blood pressure under intensified antihypertensive therapy. A follow up examination three months after the acute aortic dissection showed a constant aortic diameter. Therefore, surgical treatment was not indicated.
This case report illustrates a typical clinical picture of acute aortic dissection and gives an overview about its epidemiology, classification, pathogenesis, and prognosis. Furthermore, the diagnostic opportunities and the current guidelines for the treatment of acute aortic dissection are discussed.
我们报告一例已知患有高血压的患者，该患者因突然发作的严重胸痛前往其全科医生处就诊。疼痛始于一次牙科治疗期间。全科医生立即怀疑患者发生心肌缺血，将其收治入院。
心电图及实验室检查结果（肌酸激酶、肌钙蛋白I）均不支持急性冠状动脉综合征。由于血浆D - 二聚体水平升高，经胸超声心动图显示右心室应变的离散征象，不能排除肺栓塞。由于疼痛剧烈且为进一步诊断，患者接受了造影剂增强计算机断层扫描（CT）。
诊断、治疗及病程：造影剂增强CT显示为B型急性主动脉夹层。根据目前B型主动脉夹层的治疗指南，采用了保守治疗方案。加强降压治疗。此外，患者短期接受了镇痛药治疗。三周后，患者在强化降压治疗下无痛出院，血压正常。急性主动脉夹层三个月后的随访检查显示主动脉直径稳定。因此，未行手术治疗。
本病例报告阐述了急性主动脉夹层的典型临床表现，并概述了其流行病学、分类、发病机制及预后。此外，还讨论了急性主动脉夹层的诊断方法及当前治疗指南。
