High incidence of diseases in winter, beware of "vascular bombs"

According to media reports, a 90-year-old grandfather in a certain place repeatedly had chest pain for more than a month, the local hospital did not clarify the cause, and did not carry out special treatment, suddenly one night the grandfather chest pain worsened, sent to the hospital for rescue, check the chest CT to indicate aortic arch, descending aortic aneurysm-like expansion, the elderly are dying, the condition is very dangerous. After the emergency rescue of medical staff, the elderly patient with aortic dissection was finally snatched back from the "ghost gate".

Autumn and winter are the seasons of high incidence of cardiovascular and cerebrovascular diseases, and also the high incidence of aortic dissection, seasonal changes often cause vasoconstriction, thereby triggering aortic dissection. Recently, Qingyuan temperature plummeted, Qingyuan People's Hospital cardiovascular district three chief physician Li Ye said that the cause of aortic dissection is very complex, common triggers are hypertension, serious trauma, pregnancy, connective tissue genetic diseases, etc., of which hypertension and arteriosclerosis are clinically most common, congenital cardiovascular malformations, Ma Fan syndrome, aortic atherosclerosis and other high-risk groups of aortic dissection should pay special attention to early symptoms and go to the hospital for treatment in time.

A cough may rupture the arteries

Not long ago, Ms. Wang, who was 38 weeks pregnant, was walking when she suddenly had chest pain and black eyes. After being sent to the hospital, Ms. Wang was diagnosed with A-type aortic dissection, and cardiothoracic surgery and obstetrics decided to work together and operate immediately, which ultimately saved the mother and son. Nowadays, it is winter, it is the high incidence of cardiovascular disease season, the public usually hears more about "myocardial infarction", and rarely hears of aortic dissection.

What exactly is aortic dissection? Li Ye said that the aorta is the largest arterial blood vessel in the human body, and it is also the main pipe that transports blood from the heart to the whole body artery, and its shape is similar to an umbrella rod protruding from the heart, and the top is curved, also known as the "aortic arch". The aorta consists of a three-layer structure, the thinnest of which is the inner membrane, the middle is the middle membrane, and the outermost is the outer membrane.

The membrane and the outer membrane are separated, and the blood is sandwiched between these three membranes, forming a structure like a three-splint plate, and gradually expanding along the direction of the aorta, forming a separation state of the true and false two lumens of the aortic wall, called aortic dissection.

It is precisely because of the extremely dangerous nature of aortic dissection that some people figuratively compare aortic dissection to "an untimely bomb in the human body". Li Ye explained in detail that after the formation of the pulse dissection, the artery wall will become thin and brittle, and a cough may rupture the artery. Therefore, some people figuratively liken the aortic dissection to "an untimely bomb in the human body".

Aortic dissection onset is urgent, the disease progresses rapidly, is a very dangerous disease, if not diagnosed and treated in time, the patient's case fatality rate increased by 1% per hour within 48 hours of illness, reached 70% in one week, and up to 90% in three months. Only a very small number of patients can survive long-term with conservative medical treatment, or achieve natural healing of the lesion and disappearance of the pseudo-cavity.

Statistics show that 74% to 90% of patients with acute aortic dissection have initial symptoms of sudden and severe "tear-like" or "knife-like" chest pain, which also radiates to the back. The age of onset of aortic dissection is generally 45 to 70 years old, and the incidence is slightly higher in men than in women.

Li Ye said that unlike patients with myocardial infarction, the chest pain of myocardial infarction patients is persistent and intense, showing a gradual intensification; but the chest pain symptoms of patients with acute aortic dissection peak as soon as they appear, and this pain is often not relieved. In addition to chest pain, patients with aortic dissection will also have other clinical manifestations, such as chest tightness, shortness of breath, abdominal pain and cardiovascular system abnormalities patients will have nausea and vomiting, dyspnea, chest tightness, dizziness and other symptoms, and some patients will feel stomach pain, vital signs are fast heart rate, high blood pressure.

The "culprit" is high blood pressure

What should the public do when they find that someone around them has severe chest pain or related symptoms? In this regard, Li Ye said that it is necessary to take into account the possibility of the existence of aortic dissection, try to maintain composure, rest in a flat position, avoid large activities and emotional agitation, and dial 120 to the hospital in time to avoid delaying the treatment of the disease.

In his view, the aortic dissection is dangerous, and timely treatment is particularly important. For patients diagnosed with aortic dissection, doctors will take a variety of treatment measures at the first time to avoid the aortic dissection from continuing to tear, relieve pain, stabilize blood pressure, control heart rate, and reduce the pressure on the aortic wall. To prevent death from acute pericardial tamponade, aortic rupture bleeding, and severe organ ischemia, most patients require surgery.

Many citizens believe that cardiovascular diseases are generally middle-aged and elderly diseases. In fact, in daily life, even pregnant women will also be recruited. What are the triggers for aortic dissection? Li Ye said that the onset of aortic dissection is like a breach of the levee, which is nothing more than because the water level of the river is high, or the quality of the levee is poor. Therefore, the causes of aortic dissection include two aspects: high blood pressure and poor blood vessel quality.

Aortic dissection is closely associated with hypertension. High-speed, high-pressure blood causes a strong shear force on the arterial lining at the aortic arch, and when blood pressure is significantly elevated, the shear force of blood flow may tear the aortic lining, and blood flows along the opening between the intimal layer and the middle membrane layer, tearing these two layers of tissue apart. If hypertension is not effectively controlled, once the blood vessel wall ruptures and the dissection "breaks the embankment", the patient will die due to heavy bleeding.

Poor vascular quality, congenital such as Marfan syndrome, congenital vascular dysplasia, easy to rupture; there are also acquired factors, such as arteriosclerosis or aortic aneurysm, hyperlipidemia, pregnancy, trauma is prone to aortic dissection. Therefore, patients with congenital cardiovascular malformations, Marfan syndrome, aortic atherosclerosis and other patients are all "high-risk groups" of aortic dissection.

Aortic dissection occurs during pregnancy is also because of poor blood vessel quality, after pregnancy, the pregnant woman's body is nourished by a large amount of estrogen, which may be hundreds of times higher than when non-pregnant, the estrogen receptor of the aorta is reduced under the action of a large amount of estrogen, the reticular fibers and elastic fibers are reduced, and the elasticity and toughness of the middle aorta become more fragile than ever. Coupled with an increase in cardiac output during pregnancy, which increases the pressure on the walls of blood vessels, the enlarged uterus in the third trimester compresses the aorta. In addition, some women will have hypertensive disease during pregnancy, which aggravates the damage to the heart and blood vessels. Many factors combined give the aortic dissection, the "devil", the opportunity to sneak up on pregnant women.

High-risk groups should improve their living habits

The disease of aortic dissection is developing rapidly and the mortality rate is high, how should the public pay attention to prevention in daily life? Li Ye said that especially some people who are prone to "recruitment" such as hypertension and poor living habits should pay more attention to it, and should try to avoid related precipitating factors in daily life.

Hypertension is one of the main triggers for the occurrence of aortic dissection. Many patients with aortic dissection do not know that they have high blood pressure at the time of onset, or know that they have high blood pressure but do not take regular medication to control it, resulting in particularly high blood pressure at the time of onset. High blood pressure is not controlled for many years, just like the long-term high water level of a river, "breaking the embankment" can occur at any time under certain triggers. In other words, the control of hypertension has a comprehensive impact on the prevention, treatment and prognosis of aortic dissection, and is a preventive measure that cannot be ignored.

Some genetic diseases, congenital diseases lead to lesions in the aortic wall itself, such as the daily mention of Marfan syndrome, patients with the disease are usually different from ordinary people, height is mostly between 1.8 meters and 2.1 meters, fingers and toes are slender, often high myopia, it is recommended that people with these manifestations and family history, as soon as possible medical examination.

Long-term poor eating habits, smoking, alcoholism can lead to atherosclerosis, such as long-term high-salt diet leading to water and sodium retention, blood volume increase; long-term intake of a large number of high-calorie foods and carbohydrates, can lead to increased blood pressure.

In addition, pregnancy is included, which also increases the incidence of cardiovascular disease. Significant increase in blood volume during pregnancy, especially in the third trimester, or in patients with pregnancy-height disease require vigilance for the occurrence of aortic dissection.

Li Ye believes that for people with risk factors, it is more necessary to develop good living habits: quit smoking, quit alcohol, avoid overwork; prevent diseases such as hypertension, diabetes, hyperlipidemia; regular physical examination to prevent problems before they occur. If some of your relatives suffer from aortic dissection, congenital cardiovascular malformations, Marfan syndrome, etc., please inform the doctor in time at the time of visit. The "vascular bomb" of aortic dissection is extremely dangerous, and once the dissection ruptures, the patient can die within minutes. In addition to congenital factors, 80% to 90% of the aortic dissection and hypertension-related, in the autumn and winter more frequent, hypertension patients must usually pay attention to control blood pressure, regular medication, if suddenly severe chest and back tear-like pain, must seek medical treatment in time.

■Health Knowledge D

The main sign of aortic dissection

Chest pain is a pain that occurs in the chest or radiates from other parts of the body to the chest, the cause is complex involving multiple organs and systems, the degree of the disease is different, to acute chest pain, chest discomfort is the mainstay, therefore, early recognition of chest pain, to find out the cause, to save life has important significance.

1. Multi-site pain

If the patient has pain in different parts, it may represent a tear change in the dissection, such as the patient's first chest pain, subspringoid pain, and then sore throat, suggesting that the dissection tears from the bottom up to cause the ascending aorta.

2. Chest pain, electrocardiogram but no dynamic evolution

Holter ECG changes are of great interest in diagnosing myocardial infarction, and chest pain without ECG changes requires vigilance for the possibility of aortic dissection.

3. Cardiac auscultation blunt heart sounds

Vigilance is required for ruptured dissection or bleeding into the pericardium, causing pericardial hemorrhage.

4. Diastolic murmurs can be heard in the aortic auscultation area

In patients with chest pain, a diastolic murmur should be highly vigilant once the aortic auscultation area is heard, as this may indicate that a dissected hematoma involves aortic valve rings or affects the support of the valve lobes, and acute aortic regurgitation can cause heart failure.

5. ECG shows elevation of st st segment of the lower wall lead

Because the original institution of type A acute aortic dissection is often located in front of the right side of the ascending aorta, the right coronary artery is more likely to be affected than the left side, so acute myocardial infarction of the inferior wall is more common.

When considering acute inferior infarction in the diagnosis, it is still necessary to be vigilant against the possibility of a dissectional tear and the involvement of the right coronary artery, and at this time, it is necessary to pay attention to whether there are the following three points: chest pain is very sudden, tear-like pain; there are obvious abnormalities in the blood pressure of the left and right upper limbs or lower limbs and upper and lower limb blood pressure; and X-ray chest x-ray shows mediastinal widening. In all three cases, dissection is highly likely to trigger myocardial infarction (common in the lower wall).

6. Chest pain is intermittent

When patients have intermittent chest pain, high suspicion is required when considering acute myocardial infarction. Because chest pain due to infarction is often persistent, with little or no intermittent chest pain, such as unstable angina, then intermittent chest pain often suggests the possibility of acute aortic dissection.

7. Chest pain with fever

In this setting, aortic dissection is required for etiological analysis of chest pain and differential diagnosis. Literature has reported that fever occurs in patients with arterial dissection, and the cause may be related to tearing of the endovascular lining, endogenous heat-causing source exposure, heat of blood clot absorption, as well as thrombosis, tissue necrosis, cytokines, and oxygen free radicals induced by thrombosis and tissue necrosis.

8. Severe pain, high blood pressure

When encountering hypertension that cannot be corrected by antihypertensive and vasodilating drugs (whether uradil or nitroprusside), it is important to think of the possibility of aortic dissection.

9. Young people, obese and with a history of hypertension

Regardless of whether the pain is severe or not, and what kind of changes in the ECG, arterial dissection should be routinely ruled out first.

10. Changes in the pulse of the limbs and asymmetric blood pressure

Pulse changes, usually seen in the cervical, humeral, or femoral arteries, weakened or absent on one side of the pulse, reflecting compression of branches of the aorta or blockage of the origin of endometrial lobes.