Kenaikan segmen ST di elektrod aVR elektrokardiografi di dalam kes diseksi aorta mempunyai risiko kematian yang tinggi. Ia melibatkan diseksi yang berlaku di akar aorta. Kami melaporkan kes pesakit lelaki muda yang menghidap penyakit darah tinggi, yang datang ke Jabatan Kecemasan dengan sakit dada dan sakit di bahagian kaki. Pemeriksaan fizikal pada bahagian bawah kiri anggota adalah konsisten dengan iskemia akut. Elektrokardiogram menunjukkan serangan jantung akut di bahagian elektrod anterolateral, dan kenaikan ST segmen di elektrod aVR. Ekokardiografi menunjukkan akar aorta yang berukuran 4.51 cm dan kehadiran flap intimal, meningkatkan kebarangkalian diseksi pada akar aorta dan arteri koronari. Tomography Computed Angiogram menunjukkan terdapat diseksi aorta dari akar aorta termasuk flap intimal berhampiran permulaan arteri koronari kiri, hingga ke arteri iliac utama ke arteri iliac kiri. Malangnya, pesakit memilih untuk tidak menjalani pembedahan dan akhirnya meninggal dunia selepas 48 jam di masukkan ke wad. Kes ini menjelaskan bahawa, dalam kes diseksi aorta yang hadir dengan sindrom 'malperfusion', kenaikan segmen ST pada elektrod aVR akan meningkatkan kebarangkalian terjadinya diseksi aorta yang teruk melibatkan akar aorta dan juga arteri koronari, yang menjadikan prognosis pesakit lebih teruk.
Chest pain is a common presenting complaint in the emergency room of which acute aortic syndrome is a sinister cause associated with high morbidity. A contrastenhanced CT aortogram is often performed for initial evaluation at the first instance of suspicion. We present a patient with Stanford Type A intramural haematoma complicated by haemopericardium and acute cardiac tamponade and highlight the relevant CT signs that would alert the managing physician to urgent echocardiogram correlation and emergent cardiothoracic intervention.
Acute aortic thrombosis is a rare condition, occurring mainly as a result of trauma or atherosclerosis and occasionally secondary to hypercoagulable states. We report a patient with relapsed acute myeloid leukaemia who developed an unusual complication, acute aortic thrombosis.
A 16 year-old man presented with fracture of both his femurs after a road traffic accident. Chest radiograph revealed mediastinal widening. Subsequent CT scan and arch aortogram confirmed the findings of traumatic aortic arch transection at the isthmus. He underwent successful surgical repair. High index of suspicion and prompt actions are important in managing this potentially fatal but treatable condition.
Pyrexia of unknown origin (PUO) is a frequent presentation to the Acute Medical Unit, and is a source of significant morbidity, both the psychological burden of an uncertain diagnosis and prognosis and untreated complications of the underlying pathology. We present a problem based review of the management of PUO, illustrated by a patient who recently presented to our unit with fever and systemic malaise after returning from abroad and in whom no cause could be found for more than two months. We describe a structured approach making use of complex modern techniques such as Positron Emission Tomography-Computed Tomography (PET-CT) which ultimately provided the diagnosis for our patient.
Delayed ascending aortic dissection following coronary artery bypass surgery is a rare but lethal complication. We present the case of a 54-year-old man with a delayed acute Stanford A aortic dissection following an off-pump coronary artery bypass surgery in preexisting chronic type B disease. Such a case of an iatrogenic acute aortic dissection poses a significant challenge and dilemma in choosing the best technique for coronary revascularization in this group of patients. The pathophysiology and technical options are discussed.