Case Report,Present history : Onset,40-year old male Transient “electric shock like” back and left shoulder pain Syncope Local hospital,Present history : hospital 1,Consciousness recovered (one hour after admission) Paroxysmal dull pain in left shoulder and lower back.,Present history：hospital 1,Neurological Disorders? Neurological examination was normal. Cerebral computed tomography: normal Radiography: hyperosteogeny lumbar hyperosteogeny? Symptoms relieved: discharged,Otherwise Normal,Present history：hospital 2,Renal Failure? Chest stiffness right, 123/77mmHg. water hammer pulse (+) Heart Grade (/6) sighing diastolic murmur at aortic valve area, which radiates toward the apex.,General examination,Abdomen Mild, non-focal abdominal tenderness Lower extremity diminished left lower extremity pulses.,LAB FINDINGS,Blood routine WBC 4.74G/L; Hb 129g/L Blood biochemistry Na 145mmol/L, Cl 111 mmol/L,K 4.1mmol/L, Glu 5mmol/L, Urea 5.7mmol/L, Cr 107mol/L, UA 482mol/L; CK 121IU/L, CK-MB 12.4IU/L, LDH-L 198 IU/L; AMY33 IU/L, LPS 57 IU/L, AFP4.8g/L; Thyroid function T3=1.44nmol/L，T4=102nmol/L，fT3=4.23pmol/L, TSH=3.75mIU/L.,Otherwise Normal,LAB FINDINGS,Coagulation function PT=18S, INR=1.5, D-Dimer: 2.4mg/L (2400g/L, normal:500g/L) ESR: 4mm/h.,Imaging findings,Imaging findings,Imaging findings,Imaging findings,Imaging findings,CT angiography of chest and abdomen,discussion,Discussion：general,Acute aortic dissection (AAD) Aortic dissection may present with a variety of clinical manifestations,Discussion：general,75% Misdiagnoses include: myocardial infarction cerebral infarction,Discussion：symptoms & signs,Painless: 5% Syncope：8% AAD should be considered in the differential diagnosis of syncope, even in the absence of pain.,DISCUSSION：symptoms & signs,AAD may mimic an acute coronary syndrome,DISCUSSION：symptoms & signs,DISCUSSION：IMAGING,Up to now, various non-invasive and invasive diagnostic steps are required to diagnose or to rule-out AAD in case of clinical suspicion.,DISCUSSION：IMAGING,CT and MRI of patients with suspected AAD Sensitivity and specificity of CT： reaching 100% Sensitivity of MRI is up to 95-100%,DISCUSSION：imaging,Ultrasonic cardiograms (UCG) TAS (ultrasound of the abdomen) TEE (transesophageal echocardiography),DISCUSSION：lab,Determination of D-dimer D-Dimer: 2.4mg/L (2400g/L, normal:500g/L),Discussion：Treatment,Medication MAP 60 to 75 mmHg target HR：around 60bpm Beta blockers and nitroprusside sodium Calcium channel blockers,Discussion：TREATMENT,Interventional therapeutic measures Cardiothoracic Surgery,DISCUSSION：CLASSIFICATIONS,Discussion：Prognosis,The long term follow-up The mortality rate： 68% 48hrs,Discussion：Summary,Key in the management of acute aortic dissection is to maintain a high level of suspicion for this diagnosis.,Discussion：Summary,Rigorous clinical thinking Pertinent examinations Avoid stopgap treatment measures,Thank you！,屏蔽泵配件 仉睿聪奌,39,