探索冰山:孤立性主动脉弓中断及相关高血压的检测与管理--罕见病例

IF 0.2 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Asad Ali Khan, Farhat Ullah Khan, Said Amin, Rahmat Ghaffar
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引用次数: 0

摘要

目的:及时诊断和治疗高血压,尤其是年轻患者的高血压,对于减少并发症、死亡率和费用至关重要。详尽的病史和仔细的体格检查是关键步骤。本文介绍了一个不寻常的病例,该病例表现隐匿,在引起我们注意之前一直未得到诊断。 诊断方法一名 30 岁的男性患者有疲劳、运动耐受力差和轻微头痛的病史,被诊断为高血压。他开始服用氨氯地平,没有心脏病或继发性高血压家族史。患者看起来瘦弱无力,体重指数(BMI)为 16.6 kg/m2。他的桡动脉脉搏规律,为 98 bpm,肱动脉血压为 190/90 mmHg。进一步检查发现下肢脉搏微弱,无线电股骨延迟,踝部血压为 100/60 mmHg。主动脉部位有 3/6 收缩期杂音。常规实验室检查显示,胸部 X 光片显示肋骨有切迹,主动脉旋钮缺失。进行了经胸超声心动图检查,但未得出确切结果。胸部 CT 血管造影显示,左锁骨下动脉下方的主动脉呈 "鼠尾状 "完全中断。主动脉瓣正常,未发现其他主动脉或心脏病变。患者被诊断为 IAA A 型,建议进行手术矫正。为控制血压,患者服用了抗高血压药物,并进行了端对端吻合手术。患者术后恢复顺利,四周后症状缓解,血压为 130/80 mmHg,无需服用降压药。 结果:患者为主动脉弓中断 A 型,接受了降压药物治疗和手术矫正。一个月后,症状缓解,血压为 130/80 mmHg,双侧脉搏正常。术后 CT 主动脉造影显示解剖连续性良好,无并发症。 结论轻微症状可能只是冰山一角,需要进一步检查。IAA尽管罕见,但应被视为高血压的潜在病因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exploring the Iceberg: Detection and Management of Isolated Interrupted Aortic Arch and Associated Hypertension- A Rare Entity
Objectives: Prompt diagnosis and management of hypertension, particularly in younger patients, are crucial to reducing complications, mortality, and expenses. A thorough history and careful physical examination are key steps. This article illustrates one such unusual case that had a subtle presentation and went undiagnosed until it was brought to our attention. Methodology: A 30-year-old male patient with a history of fatigue, poor exercise tolerance, and mild headaches was diagnosed with hypertension. He was commenced on amlodipine and had no family history of cardiac diseases or secondary hypertension. The patient appeared weak and thin, with a BMI of 16.6 kg/m2. His radial pulse was regular and 98 bpm, and his brachial blood pressure was recorded at 190/90 mmHg. Further examination revealed weak lower limb pulses, a radio-femoral delay, and an ankle blood pressure of 100/60 mmHg. A 3/6 systolic murmur was noted at the aortic area. Routine laboratory investigations revealed a chest x-ray showing notching of the ribs and an absent aortic knob. A transthoracic echocardiogram was performed, but it did not provide conclusive results. A CT angiography of the chest revealed a complete interruption of the aorta just below the left subclavian artery in a "rat tail fashion." The aortic valve was normal, and no other aortic or cardiac pathology was found. The patient was diagnosed with IAA type A and surgical correction was suggested. Antihypertensive medication was given to achieve blood pressure control, and surgical correction was done involving end-to-end anastomosis. The patient's postoperative period was uneventful, and at four weeks, his symptoms subsided, and his blood pressure was 130/80 mmHg without antihypertensive medications. Results: The patient had an interrupted Aortic Arch type A and underwent treatment with antihypertensive medications and surgical correction. After a month, symptoms subsided, blood pressure was 130/80 mmHg, and pulses were bilaterally normal. Post-op CT Aortogram showed good anatomic continuity and no complications. Conclusion: Mild symptoms might only be the tip of an iceberg, calling for further exploration. IAA, despite its rarity, should be considered a potential cause of hypertension.
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来源期刊
Pakistan Heart Journal
Pakistan Heart Journal CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
0.20
自引率
0.00%
发文量
64
审稿时长
6 weeks
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