Aortic aneurysm diagnostics. Ragging camp: what about aneurysm and aortic enlargement? Aortic aneurysm EKG signs

32. Diagnostics and treatment of delamination aortic aneurysms.

Pid aortic aneurysm (rozsharuvannya aorta) rozumіyut utvorennya defect (rozrivu) vnutrіshnoї Ilya Obolonkov stіnki aorta of away nadhodzhennyam krovі in degenerative zmіneny serednіy ball osvіtoyu intramural hematoma i pozdovzhnіm rozsharuvannyam stіnki aorta vnutrіshnіy i zovnіshnіy shari of formuvannyam dodatkovogo vnutrіshnosudinnogo channel (pomilkovogo prosvіtu). Sharing is often seen in the distal (antegrade) straight, and more often in the proximal (retrograde). Aneurysm (enlargement of the aorta) can be formed in a significant enlargement of aortic space, protects, and by itself the enlargement of the aorta in the row of vipads can be of a pacified nature or is absent. intramural hematoma and pressures of the aortic dysplasia, so that vital organisms (heart, brain and spinal cord, nyrcs) can be produced, with a second ischemia. Itself according to the rapta rapta aorti shaping wiklikak bil.

Osvita intramural hematoma in the area of ​​vischidnoy aorta to produce before the suppression of coronary arteries, soreness of the onset of LSh, poor blood circulation, proximal coarctation. There is a great internal hematoma, but there is a great amount of blood, and a kind of "oligemic syndrome".

Symptoms of aortic enlargement can be discouraged, which is why it is a dynamic process and the picture of aortic disease can be seen from a physical one. The stench can be practically all heart-healthy, neurological, surgical and urological problems.

The most common (in 90-96% of cases) syndrome of aortic enlargement є bil (in case of ailments with disabilities). It grows more intensively, with the maximum variability on the ear of the growth, on the view of the myocardial infarction (IM), de von incremental growths. For some people, it can be unbearable. Bіl maє razdiraє, scho razryvaє, prostrate character, can be very quick from mіstsya vіniknennya right in front of you, you can get on the cob of supernatant vagus manifestations, tediousness, blues, arterial silence. Localization of pain in RA is caused by a small ear of growth. Beel behind the breastbone, in front breast cancer, Scho imitun IM, is characteristic of proximal growth (more than 90% of cases), especially when it expands to the roots and to the reduction of coronary arteries. With a further expansion (1typa), it will move into the interscapular space, then the back of the ridge will change. The widening of the dissecting hematoma is evident in 17-70% of the ailments. Bile in the neck, throat, cracks, individuals, teeth are placed on the formation of the visual aorta and arch. Bile in the thoracic clits behind, back, lower edges is characteristic of the distal expansion, with a lot of localization in the interscapular space. The visibility of pain in the interscapular space is sufficient relief against the distal enlargement. With the widened expansion of the aorta of I and II types on the cranial aorta, it is localized in the epigastrium, hypogastrium, across, іtuyuchi hvoryuvannya shlunkovo-intestinal tract, urological aorta.

Asymptomatic (painless) stretching (krym ailments with damaged svidomosty) can be found in ailments with chronic diseases.

Mensch with frequent cob signs of aortic growth (in a sound or without a sound in a pain) can be:

Symptoms of ischemia of the head abo spinal cord, Peripheral neuropathy, syncope without local neurological symptoms (in 4-5%), which is often tied with a dissected aorta into the pericardium or pleural empty;

Aortic deficiency і GOSTR lack of blood circulation;

Ishemia nirok;

Ischemia of etching organs;

Zupinka heart and raptus death.

The date of an observational look at the aortic enlargement is variable and, in this world, it is connected with the localization of the aorta and the stage of receiving heart-vascular system... In those types of people, to navigate with the manifestation of a great growth, active data can be unaffected, or in the face of being seen.

1) AH on the cob becomes ill (in case of a possible clinical picture of shock), more often in case of distal growth (in 80-90% of cases), and more often in case of proximal one. Arterial hypotension - often with proximal enlargement. The reasons її often tamponade of the heart, either intra-pleurally or intraperitoneal incision of the aorta.

2) Asymmetry of the pulse (lowering of the second half or the visibility) and AT on the upper or lower parameters are more likely to be observed in half of the sick with the proximal and in 15% - from the distal RA (in the case of severe arterioplastic arteries). Zvuzhennya was discussed either by the enlargement of the aortic enlargement on the same artery, by the changes in the true education, or by the proximal obstruction of the antimal valve of the recumbent artery of the artery. If I want to see the asymmetry of the pulse in a sick person, we will be able to transfer the RA, we can have a good deal of treatment.

3) Aortic regurgitation with a distal murmur of aortic insufficiency - an important sign of proximal enlargement - occurs in 50-75% of patients. The noise can be heard in music, it is more beautiful to hear the bridle of the right edge of the sternum. It can be overgrowing, decreasing, growing in intensity, in fallowness, depending on the value of AT. In case of an important aortic insufficiency, there may be peripheral signs: a quick, fast, high pulse, and a great pulse grip. In some cases, with the development of congestive heart failure, as a result of the development of aortic insufficiency, the occasional noise can be cold or absent.

4) Neurological damage occurs in 6-19% of all aortic enlargement and includes cerebrovascular damage, peripheral neuropathy, loss of fatigue, paraplegia. Cerebrovascular damage occurs in 3-6% of vascular disorders, as long as there is an unchanged or other sleepy artery. There may be a loss of evidence or a coma.

When spinal arteries are detected (often with distal enlargement), paraplegia can occur or paraparesis in the case of ischemia of the spinal cord.

5) Bigger manifestations of aortic opening can be: IM, infarction nirok and іn. In 1-2% of cases of proximal enlargement, there may be a throat of coronary arteries and development of secondary IM (often posterior / lower, as a result of more frequent lesions of the right coronary artery). Through the manifestation of symptoms of aortic enlargement, myocardial infarction may not manifest itself clinically. On the other hand, with an EKG of a severe IM, it may not be recognized that the aorta is enlarged, but the stagnation of thrombolysis can lead to fatal inheritances. That is, in case of posterior / lower myocardial infarction, do not forget about the possibility of RA, and before the thrombolysis is performed, authorize it is necessary to carry out an X-ray dosage for aortic enlargement.

Expansion of the development of the cranial aorta can be affected by the development of the disease: ischemia and infarction nirok, leading to important AG and hospitals nirkova lack mesenteric ischemia and infarction in the region (in 3-5% aortic growth); gostru ishemia lower kintzivok (with extended development on arteries clubs).

6) The clearest manifestation of aortic enlargement can be pleural vipoti, often malignancy, as a result of such a secondary exudative reaction in the affected aorta, or as a result of the opening or leakage of blood into the pleural effusion.

7) Even more pronounced manifestations of the aortic shaping can be:

Pulsation of the sternoclavicular joint

Health of the trachea and bronchial tubes with stridor ulcers or bronchospasm

Hemoptysis when rozrivі in the tracheobronchial tree

dysphagia

Bloody bloody when rozrivі in stravohіd

Horner's syndrome

Head vein syndrome

Pulsation of fabric

Atrioventricular block (if septum is formed)

Lichomaniac of unclear genesis, pummeled in the infusion of pyrogenic substances from the hematoma, or even tied with her vipot

Noise, amoused by the dissection of the dissected aorta in the empty front of the heart, or the right slug with the development of the heart failure.

When the aorta is enlarged, it is important to quickly and accurately verify the diagnosis.

X-ray of the organs of the thoracic clitine, yak - by the method of verification of diagnoses, protea, possibly the first indication of signs, suspicion of aortic expansion. The date of the X-ray examination is not specific, but may be given for the implementation of these methods before the examination. The main radiological signs, which indicate the possibility of RA, є:

I. Expansion of these aorti (in 81 -90% of vypadkіv, for our data), more beautifully appear in the lіvіy kosіy projection (only locally in the area of ​​expansion, before - the expansion of the upper middle). The enlargement of the type of aorta was found in 50% of patients with type I enlargements (- and in 10% - type III.

2. Separation (appearance) of calcified antibodies in the area of ​​vipinnya from adventitia is larger, lower by 1 cm (in the norm - up to 0.5 cm) - it is possible, otherwise it is not diagnosable.

3. Change of aortic contours or midpoints in case of prediction data.

4. Vidhilennya trachea or pleural infection (often free).

5. Rise of a decrease or the visibility of the pulsation of an abnormally wide aorta. If you want more ailments from the RA, there is one or more radiological signs, in 12% of patients there is no radiograph. The appearance of changes during X-ray imaging does not allow the diagnosis of aortic enlargement to be diagnosed.

Electrocardiography in 12 standard introductions is nonspecific for RA, signs of hypertrophy of the louse and associated with her snake (depression of the ST segment, negative T wave). 1/3 of the EKG patients are normal !!! Protest, the EHC officials are important for two reasons:

The duration of changes on the EKG in a patient with a swelling of pain syndrome in the thoracic cells is a supporting differential diagnostic criterion of RA with IM;

The presence on the EKG signifies the GIM (part of the lower localization) when given with the X-ray data, it is allowed not only to let the aortic enlargement on the sickly aorta, but also to order the diagnosis of coronary arteries.

Laboratory signs are not shown in the diagnosis of aortic shaping:

a. anemia - in case of significant sequestration of blood in the khibny canal or in empty space;

b. small (small) neutrophilic leukocytosis (up to 12-14 yew / mm3);

v. prescription of LDH and bilirubin (through hemolysis of blood in the khibny canal);

m normal level of CPK and transaminase;

e. the development of the DIC syndrome.

For the data of the routine methods Smoothness, diagnosis of aortic enlargement can be delivered only in 62% of patients. Rashta on the cob may have signs of myocardial ischemia, congestive lack of blood circulation, aneurysms of the thoracic or cranial aorta, symptoms of aortic stenosis, BODY and IN. Among the aortic chickens, there are a number of undiagnosed aortic enlargements, in 2/3 of the aortic enlargements are diagnosed with the help of other diagnostic methods, victorious for the transmission of the second dietary supplements. At 1/3 of the diagnosis of the delivery of only the autopsy.

The main methods of diagnostics of shaping the aorta in the last hour include methods that allow the visualization of the aorta:

aortography

Contra-yak I'll do it Computer tomography(CT)

Nuclear Magnetic Resonance (NMR)

Transthoracic and transesophageal echocardiography.

The skin technique is not overwhelming and short-lived. Vibir method to lay down from the power and to the end.

The aortography for the last hour was seen as a standard and single precise, highly sensitive method for diagnosing aortic shaping. Direct signs of aortic enlargement in aortography є: visualization of two assignments (true and papillous), an intellectual valve, and indirect signs - deformation of the aortic opening, enlargement and deformation of the malignant vascular disease, abnormalities Aortography allows:

1.visual length of distribution

2.viyaviti the rate of aortic gillocks

3.viznachit the place of cob rasp and more precisely the place of proximal fenestration

4.the visibility or visibility of the distal fenestration

5. Assessment of the steps of the aortic valve and coronary arteries.

However, graciously enlightened, often appear in the lower aorta, in 10-15% of the tumors are thrombosed; True enlightenment when there are many sounds. With transfemoral access, the catheter may not be inserted into the aortic reference lumen. Find out the appearance of an intellectual valve (so that the inner shell is visible through the true and hybrids) is found in 1/3 of the ailments.

Lack of aortography є the possibility of rejecting hibno-negative results, which can be trapped in case of weak contrasting of the papillary lumen (through thrombosis), however, the equal contrasting of both canals, small and local enlargement.

Prior to the folding of the given method, it was necessary to introduce the risk of an invasive procedure and the introduction of contrasting speech (intolerance), the inability to display aortography in unstable (non-transportable) ailments. In addition, the introduction of alternative diagnostic techniques has shown that the sensitivity and specificity of aortography become 77-88% and 95%, apparently. So, a grave move is seen in 87% of patients with ailments, an unintelligent clap - in 70% and a small amount of cob razrivu іntimi - deprivation in 50% of patients with aortic enlargement.

Echocardiography is an affordable and non-invasive method for diagnosing RA. According to the literature, transthoracic echocardiography allows 80% of the aorta to grow. In this hour, a special role in the diagnosis of aortic shaping is introduced by the transesophageal EchoKG (sensitivity to the storage method is 95%, and the specificity is 75%), which is a method of vibration in case of an unstable condition of a sick person, which can be easily performed without promptly entrusted, not invoking monitoring monitoring and conducting therapeutic visits. Echocardiography allows the visualization of enlargement of the aortic cybulin, the improvement of the aortic stems, the function of the aortic valve, the appearance of a crumbling valve in the aortic lumen, and also gives additional information about the heart structures.

When there is a possibility of conducting through an extraocular EchoKG, by the method of vibration, a computer tomography with the introduced contrast. With contrast-enhanced CT scan, the aortic enlargement should be indicated for the appearance of two children, due to the development of an intravenous clap, or for the development of contrast (step) of contrast darkening. Method sensitivity 83-94% and specificity 87-100%.

Perevagami KT є: non-invasive, if necessary, intravenous introduction of contrast; availability; Possibility to establish a diagnosis of aortic enlargement in case of thrombosis of the grave lumen; Possibility to rise in the presence of pericardial vipot.

The main shortcomings of CT: the sensitivity of the diagnosis of aortic shaping is quite poor; unfeasibility in 1/3 of the types of cases of intactness; fertility of the establishment of the cob crop; Unwillingness to detect the appearance of aortic regurgitation and the occurrence of vertebral pain.

NMR is a non-invasive technique, as it will require an intravenous injection of contrast, if there is a high degree of imaging in decile areas. NMR detects the development of RA, allowing for the detection of the presence of gillocks, as well as diagnostics of the development of the aorta in patients with anterior aortic diseases. The sensitivity and specificity of the method is close to 98%, while, at the same time, the sensitivity becomes 88% for the installation of an intravenous and aortic regurgitation, 98% - for the diagnosis of the presence of thrombosis and 100% for the detection of pericardial disease. It is highly accurate to rob NMR with the current "gold standard" for diagnostics of RA, especially for stable ailments and chronic changes.

However, the method still has a number of shortcomings: NMR of contraindications we are sick with Pacemaker, with the presence of a singing type of vertebral cracks, by some old types of prosthetics with metal piece valves; not є widely available. Deyakі authorize vіdvazhayut all indications before carrying out NMR unstable camp of the sick, as vimagaє in / in the appointment of hypotensive drugs and monitoring arterial vise.

Treatment in case of aortic enlargement is directed to the progression of dissecting hematoma.

Bil maє buti virizana in / in the introduced morphine.

For a decrease in the heart rate and decrease in the rate of discharge of LSh, b-blockers should be used in increasing doses until the heart rate is reduced by 60-80 in min.

If there is evidence of a contraindication to the stasis of b-blockers (bradycardia, AV blockade, bronchospasm), the antagonism of the calcium canals is often stagnant at once. Nifedipin sublingual can be stored in a secret way, while it is prepared before the introduction of the drug. Not so much nifedipin is a weakly negative inotropic and chronotropic action, in connection with which there may be stagnation of diltiazem and verapamil.

In case of non-efficacy of beta-blockers, sodium nitropruside can be stuck in a dose of 0.5-10 mg / kg * xv IV.

In case of refractory hypertension, as a result of the formation of nirkovy arteries, the most effective is the intake of ACE ingibitors (enalapril - 0.625 mg intradermally for 4-6 years.

In case of hypotension, thinking about the possibility of tamponade of the heart, cutting the aorta, then, if possible, vimagaє quick renewal of the BCC. With refractory hypotension, it is important to vikoristovuvati norepinephrine, mezaton. Dopamine vicorization for polishing the function of nirok and tilka in small doses.

In case of stabilization of a sick person, it is inaccurate to carry out diagnostic pre-diagnostics to verify the diagnosis. In case of unstable condition of the sick, it is important to check TEE, on continuous monitoring and therapeutic visits.

Fake tactics start with the type of rosharuvannya.

Aortic aneurysm є the internal sheath is enlarged by the aorta, as it is supervised by the appearance of hematomas and a grave opening. The process of becoming ill is characterized by a late subdivision of the aortic walls of varying length. In medical pathology, it is often called a faster variant - "aortic expansion".

The most frequent dissection of the aorta can occur in the most hemodynamically weak muscles, up to which the area of ​​the viscid aorta, the aortic arch and the decay zone are included. In cardiology, aneurysm is included in the group of important pathologies, which can cause unhappiness and clog the life of people. In case of unprecedented brutality to the lykarya, the patient may experience bleeding from the aortic opening, gostra ischemia.

As a rule, an ailment develops in Lithuanian people, who are already over 60 years old. Doctors often diagnose pathology in choloviks, but not in females. People have more size of aneurysms, more progress is made to grow and grow chances of developing. As a rule, the size of the aneurysm is growing, which can be in the range of larger than the norms of the diameter of the aortic space.

Ethiology

Rozsharuvannya aneurysms for reasons... The chief bureaucrat, scho to produce ailments before the development, In case of pathology in the aorta, people repair specific plaques, which can serve as a provoking factor. The price of the new solution is stored in cholesterol, calcium and fibrous tissue. With the progress of atherosclerosis, the number of plaques will decrease, which will lead to a decrease in education in the vessel. As a result, the walls lose their elasticity and become more weak. Also, clinicians see and internal officials who can produce aortic dissecting aneurysms:

• bobbing a wag;
• recession;
• advanced indicators arterial vise;
• implantation to nikotin.

Pathology can be developed in the presence of others young people... There are high chances for aneurysms to appear in people with such ailments:

Delivering a rare ailment is diagnosed through a mechanical process.

Classification

Classification of ailments of the disease in identified types of ailments according to their particularities, and according to the localization of ailments. For the first criterion, the doctors were seen to complete the systematization, how to follow these forms:

• chronic - can run in months;
• підгостра - the process is close to 4 times;
• gostra - the fatal result is insisted in a couple of years after being sharpened.

For the place of ailments, the classification of ailments is divided into 3 types:

• Type 1 - the expansion of the visceral aorta, and smoothly transition to the chest and cranial area;
• Type 2 - localized localization viklyuchno in the vishidnom view;
• Type 3 - from the lower zone and the urge to move to the area of ​​the cranial viddilu of the aorta.

symptomatology

At the outlet classic paintings pathology doctors see two stages of formulation. With dissecting aortic aneurysm on cob stage ailment manifests itself in three great forms of illness - gostra, pidgostra, chronic.

In case of a hostile attack, the growth of the sick person should add the following symptoms:

Exfoliating aortic aneurysm is such an ailment, when there is a strong feeling of pain, it can provoke the appearance of a reflex change in blood pressure and obscurity. After an hour, the sick person will fix the strong pains of the baking character in the sternum, on the arms, shoulders, shoulder blades. At the moment of aggravation, the patient manifests itself with other symptoms: dry cough, the appearance of an unstable twinge, a decrease in blood pressure, collapse.

diagnostics

The development of aortic ailments from the expansion of the walls is possible only with instrumental obstruction. For an exact definition of the cause of the development of pathology, a sick person should be diagnosed with such methods;

• radiography;
• tomography;
• angiography.

The caregivers behind the EKG help can prevent myocardial ischemia, as it also provokes pain in the chest. Radiography of additional help to detect changes in the structure of the court - improvement of education and the upper middle, change of contours, presence of pleural vipotus, decrease in pulse in the expanded part.

The ailment is recognized to be constantly controlling the arterial grip, decreasing and guarding the changes of the EHC. To determine the dynamics of the progress of aneurysms and the presence of a line in the pericardium and pleural spines, the patient undergoes X-ray.

It is important to perform tomography for the detection of intramural hematoma, penetration of atherosclerotic virazok of the thoracic aorta.

In the diagnosis of ailments, it is also important to carry out a differential treatment and diagnosis of aneurysm from such ailments:

• occlusion of mesenteric vessels;
• gostry;
• aorta;
• without rosharovvannya st_nok;
• pukhlina middle.

lykuvannya

If an aortic or thoracic aortic aneurysm is diagnosed in a sick Bull, then therapy is indicated in the presence of the type of growth and manifestation of the inheritance.

Medicamentous therapy is victorious in the treatment of developmental forms of aneurysms. Likas є the cob stage of the deterioration of symptoms and causes of the onset of ailment. Because of the patient's symptoms, aortography and surgery are indicated.

Likuvannya medications primed for the following purposes:

• prevention of the development of false aortic growth;
• normalization of hemodynamics and homeostasis;
• Change of indicators of arterial vise.

Doctors recognize the treatment of pathology with drugs from such groups - beta-blockers, calcium antagonists, іngіbіtori APF, Nitroglycerin.

If it is conservatively lіkuvannya іkuvannya viyavilosya maloeffektivnim, then the ailment is recognized promptly entrusted. Vono primed on the fact that the resection of the damaged part of the aorta is done, and the grave education and the new part of the aorta are updated. For the purpose of reaching the doctor's goals, the prosthetics are victorious, or they see the zone with the defect, and the end of the healthy aorta is sewn up.

An emergency need for operative assistance is only necessary for these patients, for those with a threat of aortic opening - with severe vascular insufficiency, progressive enlargement, with saccular aneurysm, with ineffective therapy by conservative methods. Also, terminova surgical help appears, as in the case of a sick person there is a hemorrhage at the pericardium or a pleural empty space.

Most often, such operations are carried out on the basis of piece blood circulation. During the course of the surgical aid, the sick person insisted on the stage of rehabilitation in the hospital.

accelerating

A collapsed aortic aneurysm may develop, like a stratified aortic aneurysm, develops a little more quickly or a patient is medical aid... Prior to the most frequent inheritance of ailments, such pathologies are reported - myocardial infarction, insult, rarely - aneurysm opening and fatal result.

forecast

For people with a detailed diagnosis, the result can be unpleasant. Chimala is a part of the children who die before the hour of the operation, or in the period of renewal. Doctors found out that in case of acute therapy of aneurysms on the operating table, a lethal result occurs in 25% of cases, and in case of chronic ailment in 17%.

prophylaxis

Aortic aneurysm is a very important form of getting sick, and it is important to mark it on the cob. In order to change the chances of ailments occurring, to periodically reverse the indicators of arterial grip. As soon as the patient has a high level of blood circulation, then, for preventive purposes, it will be indicated to take therapy and hypo-polydemic drugs.

Also, doctors to please us with people by going in for sports, pursuing their own food and achieving a healthy way of life.

Is everything correct in the statistics from a medical point of view?

Give an explanation only in the same way, if you have a medical knowledge

The aortic aneurysm was taken to be nazivati, having established itself in n_y enlightenment, which changes the normal diameter of the sudin two times (and more). A defect appears as a result of the ruining of elastic fibers (filaments) of the central shell, as a result of which the fibrous tissue has been poured into it, thus expanding the diameter of the blades and bringing them to the springs. In the world of development of aortic aneurysms, development of aortic aneurysms.

Classification of aortic aneurysms

In the surgery, there are a few classifications of aortic aneurysms: in the number of cases of walking, localization of segments, the nature of the clinical transition, the structure of the aneurysmal mouse and the form.

For the localization of the onset of the type of aortic aneurysm of the thoracic viddil:

• aneurysm of the viscid aortic artery;
• sinus Valsalvi;
• arc areas;
• the lowest part;
• cranial and thoracic viddiliv.

It means that the diameter of the viscid aorta in the norm is guilty of folding close to 3 cm, and the lower one - 2, 5. The cherevna aorta, in its own devil, is guilty of not more than 2 cm. normal indicators mayzhe 2 times.

For localization of aneurysms of the cranial cavity of the aorta, it is possible to develop:

• suprarental aneurysms (to lie up to the upper part of the cranial aorta with vyhidnye hilkami);
• Infrarenal aortic aneurysm
• total.

Here are some of the following:

• aneurysms of the podbanі (non-inflammatory, fiery character, Idiopathic);
• like.

Classification of aneurysms by form:

• Mishechkuvati - presented in the viglyad of the interlaced type of wall (not borrowing and half of the aortic diameter);
• pidrozdіlyayutsya on clubs, bichni, which expand and descend into the pelvic area of ​​the artery;
• spindle-like aneurysm of the aorta - vinikє as a result of stretching of the aortic stem throughout the entire cola or part of the segment;

For the structure of the mouse, aneurysms are developed:

• pomilkov aortic aneurysm, or a pseudoaneurysm (the stink of a cicatricial tissue).
• true (budova such aneurysms make up the structure of the self).

Regularly from the keynote perebigu look:

• dissecting aortic aneurysm;
• asymptomatic aneurysm;
• accelerated;
• typical.

Under the term "aneurysm has been slowed down", rely on respecting the opening of the bear, which, as a rule, is supervised by clear internal bleeding and increased hematomas. Not included in the given situation and thrombosis of aneurysms, which are characterized by increased reliance on blood flow.

One of the most unsafe manifestations is the artery aneurysm. In this vypadku through the lumen at the inner obolontsi pass the roof, which penetrates between the balls of the aortic stems and grows along the vessels under the pouring vice. In addition, the development of aortic aneurysms is observed during the process.

Is it necessary to know about aortic aneurysms?

As it was said earlier, all aneurysms go on and on. The growth of the first is characterized by aortic aortic ailments of a decongesting nature (fibrous dysplasia, Marfan syndrome, Ehlers-Danlos syndrome, congenital wadi elastin and Erdheim's syndrome).

Aneurysms of an unsettled character are diagnosed for a long time ignition processes, Caused by specific (syphilis, tuberculosis) and nonspecific aortitis ( streptococcal infectionі rheumatic fever), And also as a result of fungal infections and infections, which were caused by prompt involvement.

As for non-inflammatory aneurysms, the main reasons for the diagnosis are the appearance of atherosclerosis, the transfer of prosthetics and defects, which are accepted by the application of seams.

The core of the aortic system. This type of aneurysm is traumatic in nature.

Do not go without respect і vіk people, the manifestation of arterial hypertension, ominous alcoholic beverages, kurennya. In this case, the development of Sudin aneurysms is also great.

Description of cranial aortic aneurysms

Aneurysm of the cranial aorta is most often diagnosed in people older than 60 years. Especially, risky development of the disease grows with the regular adduction of the arterial grip and currents.

Aneurysm of the cranial aorta is manifested in the eyes of dull, numb and stepwise growing pains in the abdomen. Inadvertently, as a rule, they are seen from the navel and from the back, from across to across. When such symptoms appear, it turns to a lykarya, in which aneurysms of the cranial aorta can open up.

Before indirect symptoms occur:

• loss of waste at vase;
• haircut;
• constipate, scho trivayut up to 3 days;
• ruinous sechovipuskannya;
• attack nirkova coli;
• ruinous destruction in pictures.

Also, in case of a celiac aneurysm, there can be problems with running through impaired blood circulation.

Thoracic aortic aneurysm. describe the affliction

In case of aneurysm of the visceral aortic appearance, the patient is screeching for severe pain in the breastbone and in the heart. If it is enlightened in the meaning of the world, then it is clear that it is empty upper veni Of course, there can be a lot of problems on the faces, hands, shia, as well as mіgren.

Aneurysm of the aortic arch is often symptomatic. It is localized in the area of ​​the shoulder blades and behind the sternum. The aneurysm of the aorta of the thoracic viddil is tied without interruption to the hindrances of the organs of the organs.

With tsom:

• there will be a strong grip on the stravohid, through which the covtal process and the bleeding will break down;
• ailments vidchuvaє zadishku;
• to prevent sleepiness and bradycardia;
• greetings rotary nerve characterized by a dry cough and the appearance of hoarseness in the voice.

When the cardial part of the slunk is squeezed, there is pain in the 12-palate intestine, nudota, bloating, inappropriate views into the shlunk, cutting.

Low aortic aneurysm severe pain in the area of ​​breast cancer, sickness, anemia and cough.

Kudi to hide and how to get sick?

Aortic aneurysm of the heart is diagnosed with additional decile methods. One of the most victorious is radiography. The procedure is carried out in 3 steps. The head with a good X-ray is more visual to the education of the stravohode. On the sign of aneurysms of the low form of the artery, they appear in the lung.

Slide to mean that most ailments show up a little less than a favor to the stravohove. In the solution, calcification is a local purchase of calcium from salts in an aneurismatic small bag.

If one suffers from cranial aneurysms, then in this case, X-rays show the manifestation of calcification and Shmorl's grizzly.

It is more important to diagnose aneurysms with ultrasound of the aortic heart. Before it is allowed to develop the size of the viscous prospect, the deciduous, as well as the aortic arch, the cranial capillaries. The ultrasound scan will show the body of blood-bearing vessels, which can be seen from the aorta, as well as changes in the area of ​​the wall.

CT scan is also known to have established aneurysms and caused aneurysms of the cranial artery.

The incidence of dissection of aortic aneurysms with sizes less than 5 cm is minimal. Called in such a way to get sick to seek additional medications, as to become stagnant for the therapy of a high arterial grip. Beta blockers are introduced before them. Such preparations will speed up the strength of the heart very quickly, change the strength and bring the grip back to normal.

Likewise, you can prescribe drugs to eliminate high levels of cholesterol. It has been reported that the stink of changing the risk of lethal result and attack and insult has been reported.

As soon as the aneurysm reached the size of 5 cm, then the doctor, better for everything, to designate the operation, as well as to determine the operation, as well as to confirm the thrombosis. Surgery for visible aneurysms and prosthetic repairs and localization.

As soon as the doctor has revealed an aortic aneurysm, then, better for everything, I will recommend to radically remember the zvichny way of life. For the cob slid shkіdlivyh ringtone, Zokrem: kurinnya and vzhivannya of alcoholic beverages.

Prevention of aortic aneurysms in polygons in implanted products, corny for the heart (kiv, sauerkraut, citrus) and in physicists, they have the right to increase the frequency of hearts.

symptoms

Symptoms of the cranial aortic aneurysm

Most often, such pathology is in black empty... I was sick before falling ill in the main firing of choloviks at the age of 60 years. In folding vipads, multiple aneurysms of the cranial viddyla of the aorta are established. Symptoms in the most vipad flare.

Well, you can see a patient when you vipinnya the walls of the dish, the abdomen, constipate and fix the persecution, reduce the vagina. With great sizes of aneurysms, it is possible to namatsati in an epigastric period with pulsating illumination.

If the expanded embossing is on the navkolishny nerves and fabrics, there may be embellishments, ruining the functions of the secular paths and creating paresis nig. Alle most often, with aneurysm of the cranial aorta, the first signal is to attack the pain. They occur unsupported, often extend across the groin or legs. Bіl triva kіlka years and disgustingly let it flow in lіkіv. If aneurysms are inflamed, the temperature may rise. In some cases, the fingers are blue and cold.

Thoracic aortic aneurysm symptoms

Most of the diagnostics of the disease, as well as the enlargement of the judgment is localized in the area of ​​the aortic arch. Symptoms when there are more turns.

It is most common for patients to skip for small throbbing pains in the chest and back. Falsely, the aortic enlargement can be seen in the shoulder, or in the upper abdomen. Moreover, extravagant antibiotic drugs do not help children.

It also helps to develop a dry cough and aneurysm embossed on the bronchi. Inodi expansion of the court is embossed on the nerves of the core. That is when you see it when you are overwhelmed, there is chilliness and hoarseness.

Protodiastolic murmur is often observed through the enlargement of the aorta and the control of the bloodstream in case of aneurysm of the viscous aortic cavity.

With a large aneurysm, enlargement can be observed with visual inspection. There is a small pulsating fluff in the sternum area. You can also swell the veins in the shia.

Symptoms of aortic aneurysms

The pathology of the artery in the whole of the world may not manifest itself for a trivial hour. Ailment infrequently occurs in the heart, which is known by pills. Some of the symptoms are: stuntedness, coughing, and poor motility, which may also be due to heart failure. Often the disease is diagnosed to be deprived of a strong attack of angina pectoris during the EKG.

Symptoms of aortic aneurysms in the brain

Expansion of small sizes does not show itself to itself. Mothers may have a headache, or with similar symptoms of a patient's symptoms, they can quickly turn into a drug. It is possible to get sick with a great aneurysm, if it is embossed on navkolishny nerves and fabrics. With a wide range of ailments, these are the views:

the pain is localized not only in the head, but in the apples;

you can make a cloudy dawn;

Inodi evolve at the expense of the sensitiveness of the shkiri of denunciations.

Signs of a rosharuvannya or aneurysm development

In the case of a bagatech of illnesses, it is diagnosed as soon as it appears. In the case of great spindle-like enlargements, aneurysms grow wider. Also part of the buvay in the cranial viddili aorta. Small miserable aneurysms with increased blood pressure may develop. How many symptoms are spontaneous with such acceleration?

Persha sign - tse sharp bile... Vona is bottled step by step from one moment on all heads or on a black empty. In case of aneurysms of the thoracic appearance, it is often taken for the manifestation of an infarction.

The patient's squeeze will drop sharply. I start to feel the signs of a shock: I’m a little boy, she’s involved in anxiety, doesn’t respond to food, and starts to get lost.

Aneurysm can be recovered from a sick person at any moment. At the time of the daily medical assistance, the death of the patient often ends. To that, be it the loss of self-esteem and troublesome symptoms of innocence, be lost without respect.

diagnostics

How to develop an aortic aneurysm, how can it develop asymptomatically in a number of cases, and appear as if it is normal, or if it’s rosted, but not if it’s a cause of death? Deyakі vipadki Mayut specific signs aortic aneurysms and produce to all sorts of slowdowns, cluttering the life of people. Danes become ill most often spared from people who have been kidnapped. Cyclic pathologies of the vertebral column, hypertension and impaired metabolism.

There are two types of aneurysms that develop in the body of people:

• Aneurysm of the thoracic aorta - located in the thoracic cavity;
• Aneurysm of the cranial aorta - to be found in the crank empty.

The development of aneurysms depends on their shape, parameters and obvious acceleration. Signs of aortic aneurysms can be seen in the presence of ailments and the method of surgical intervention. Decreased internal bleeding in 2 drops from 5 to a fatal result.

diagnostics

Diagnosis of aortic aneurysms is important for several reasons:

• Signs of aortic aneurysms do not appear;
• Symptoms for those with illnesses (for example, cough and discomfort in the chest cavity are more likely to occur in patients with illnesses); Pathology is rarely learned in lykarsk practice.

If the sign of illness is evident, it is necessary to consult a therapist or a cardiologist. stink first glance, The results of which are considered rigorous. The diagnosis of aortic aneurysm is often confirmed when the diagnosis is carried out.

How to diagnose aortic aneurysm?

Diagnostics of aortic aneurysms

• A physical look to serve for the collection of the first tributes (skarg) without the collection of folding methods. Diagnostics of aortic aneurysms in polyagus in a callous survey, percussion (prostokuvannya), palpation (promising), auscultation (hearing with a stethoscope) and vimiri vise. Pislya viyavlennya characteristic signs indicate a further diagnosis of aortic aneurysms;
• X-ray showing the internal organisms of the breasts and abdomen. On the sign of the good one can see the vipinnya of the aortic arch or її zbіlšennya. To reveal the parameters of aneurysms, a contrasting tongue is inserted into the vessel. Due to the lack of safety and trauma, such diagnostics of aortic aneurysms is designated as special indicators;
• Electrocardiography is used to determine the activity of the heart meat. EKG aneurysms aorta can help you get sick from ischemic ailments heart. With atherosclerosis, a servant causing aneurysm formation, suffers from coronary artery disease, which may cause an infarction. How to find aortic aneurysm? On the cardiogram, it is possible to show specific signs of aortic aneurysms, the type of pathology of the heart-vascular system;
• Magnetic resonance and computer tomography give the possibility of all the necessary parameters of aneurysms - growth, size, shape and size of the dishes. Pathognomonic CT-signs of aortic aneurysms are shown to increase the size of the wall and expand the education of the judge. At the beginning of the meeting mozhlive lykuvannya;
• Doslidzhennya ultrasound - ultrasound aneurysm of the cranial aorta є one of the advanced diagnostic methods. Vono additionally helps to increase the fluidity of the blood flow and the apparent vorticity, swirling of the judgment;
• Laboratory analyzes include laboratory and biochemical analyzes of blood, as well as slaughter. How can you diagnose aortic aneurysm by analysis? They have such signs of aortic aneurysms: Decrease in the number of leukocytes, which is typical for hospitals, or chronic forms of infectious ailments, as to overcome the establishment of aortic aneurysms. It also helps to increase the number of non-segmented neutrophils. The improvement of the laryngeal blood is manifested in the presence of an increase in the level of platelets, changes in the factors of the larynx and in the case of the formation of blood clots in empty aneurysms. A high level of cholesterol shows the appearance of atherosclerotic plaques in the vessel. In the analysis of this, there may be a small amount of blood.

Pererakhovani signs of aortic aneurysms are not є characteristic symptoms This disease does not appear in all patients.

lykuvannya

When carrying out diagnostic tests and diagnostics of "aortic aneurysm", there are several options for the development of the pod. One of the options can be dynamically cautious in a forensic surgeon, and one of them is without a priori treatment of aortic aneurysms.

Dynamically cautious and roentgenologic dosage is shown to be less than that, if the disease is asymptomatic and non-progressive, aneurysm of small size (up to 1-2 cm). As a rule, such a diagnosis is made as a result of passing the medical committee or a medical look at the robot. Such a motive may be deprived of the reason for the persistent caution and prophylaxis of young accelerated patients (antihypertensive and anticoagulant therapy). Medication for treating aortic aneurysms does not get stagnant through the appearance of effective specific drugs.

I would like to know about the effectiveness of Siberian herbs, spring crop infusions and others in the treatment of aneurysms, diseases folk zasob as before, it became completely ineffective and incompetent, and it could be stagnant either in the process of operational rehabilitation, or as a non-traditional method of non-specific prevention. Before such procedures

The only vipads shown are only surgical involvement.

If there is no surgical treatment?

Prototypes shown before operation є:

• The state of impairment of coronary blood circulation is a history of infarctions, which appear on the EKG for the last three months;
• The state of impairment of cerebral blood circulation with the appearance of neurological symptoms - insult and post-insult;
• Evidence of mental deficiency or active tuberculosis,
• Reveal of nirkovo disability, moreover, it’s like an accursed one, so it’s obvious.
• Svidoma vidmova people and hope vilikuvatisya without operation.

surgical treatment to achieve profitably and reliably lie in the form of aneurysms, її localization, the possibilities of a cardiological stationary and about the center and quality of a forensic surgeon. At the same time, scho techniques to complete the bagato (it is written about them below), the skin patient with an aneurysm before the operation will take away the preoperative training. Vona polyagaє in the offensive: approximately 20-24 years before the operation, carry out specific antibiotic therapy, sensitive to staphylococci and intestinal stick... Also, before the operation, the patient has gone out of the way of products and nothing is left for 10-12 years before the operation.

Regularly from the localization it is seen:

• aneurysm without anterior aortic arch (coming out of the empty heart), thoracoabdominal aortic aneurysms,
• viscid aneurysm
• aortic aneurysm Operation of aortic aneurysms, or, more precisely, the technique of carrying out, without predominantly lying in the form of an aneurysm of the aortic class.

Treatment of aneurysms of the thoracic and viscid aorta.

Surgical treatment of ailments with aneurysm of the thoracic aorta and viscid symptoms are susceptible to:

• Radical involvement - at the end of them, edge resection and resection of aneurismatic emptying from replacement with a prosthesis from synthetic materials will be stuck.
• Palliative - grasping the thoracic aortic with a prosthesis. Such an operation is performed only in quiet areas, as it is not possible to perform a radical operation and when it comes to risky aneurysms.

It might mean that an extraordinary operation is to be seen in that case, that it is necessary to treat aortic aneurysms, and terminov - in case of slowed down aneurysms by melena, pain syndrome and the appearance of hemoptysis.

Craiova radical resection is performed in case of mishkuvati (mishkopodibny) aneurysms and if you borrow a third of the aortic radius. The essence of such an operation is in the resection and in the visualization of the aneurysm and suturing of the aortic wall with sutures in the two surfaces of the clock to fix the local blood flow.

Tangential resection does not transfer blood flow through the aorta - in the same surgical technique as well.

Radical resection from endoprosthetics appears to be in that case, as the aneurysm is spindle-like and loses more than a third or half of the circumference of the aorta.

The technique, in principle, does not take the form of a marginal resection for the blame of the moment when an endoprosthesis is installed on the site of a resected aneurysm - if the prosthesis is implanted, the blood is included in the prosthesis.

The operation of aneurysms of the viscid aortic viddyla is carried out either simultaneously, or because of the lack of the aortic valve. During a one-stage operation, up to one endoprosthesis is fitted with a biomechanical aortic valve. In cases where the aortic insufficiency is mute and only the viscous aorta is affected, special fragmentation of the prosthesis with rigid (static) frameworks, so the names of the combination prosthesis, are stuck. The essence of such a method of polyanga is in the fact that the rosette in the aorta of such explants is carried out to the inevitable edges of the aorta and is fixed with specific measures. Then, over the implanted endoprosthesis, the aortic staple is sutured tightly. Perevaga її in that such a technique allows to speed up an hour of blood flow through the main vessels by 25-30 khvili.

Treatment of aneurysms of the cranial aorta.

Surgical treatment of aneurysms of the cranial aorta is stagnant with aneurysmatic enlargement of the aorta twice as low, or with a diameter of 4 cm.

Preoperative preparation, in addition to the main stages, including the general correction of abnormal pathologies, which may accelerate the surgical treatment (atherosclerosis, arterial hypertension, instability of the angina pectoris) Infrarenal aneurysms are operated from the middle laparotomic approach, with suprarenal and total aneurysms, left-sided thoracophrenolumbotomy laparotomy is performed along the ninth intercostal space. The operation can be carried out behind the decilcom by methods:

• The aneurysm is resected and a little shock is seen, and then aortic prosthesis is violated, or bypass.
• The aneurysm is resected, a little mischief is not seen, and a prosthesis is placed on the first place or a shunt is placed.
• Endoprosthetics for aneurysms of the cranial aorta: endoprosthesis is installed on the frameworks (it can be fitted with or without resection of aneurysms).
• Stenting of aortic aneurysms is stagnant in case of advanced surgery and surgery for operational acceleration... The essence of such an operation is in the setting of an anesthesia in an open stand, which can open up to an aneurismatic mouse, and by itself is involved in the bloodstream.

For the operation of aneurysms of the cranial aorta, the patients are shown rehabilitation in the depletion of the "malignancy" process, which was found in the course of diagnostics and recovery of the accelerated standard. In the main rehabilitation of the field in correct eating, Vidmovu from a shkidlivy little call, a healthy way of living and in the middle of physical life.

Among the most frequent localizations of aneurysms, there is another form: aneurysm of the aortic heart. Treatment with such localization is shown as a rule of thumb in cases of aneurysmal enlargement of 6 cm, conservative therapy and active progressive process.

In vipads, if there is a lack of a mitral valve in the order of the aortic aneurysm, MK plastic is performed. In case of aortic aneurysms with such background diseases, the mitral valve pid gallant anesthesia replace with a piece implant. Such operations are carried out on the basis of a piece of blood circulation apparatus for the operation of a heart meat robot.

liks

Medicinal ailments do not get rid of, ale є prophylaxis and rehabilitation of the operation. Yakis vitamins, drugs are taken. Write about tse. The development of the process to the treatment through the operation.

People zasobi

Treatment of aortic aneurysms for the help of folk

In case of aortic enlargement and aneurysm development, no surgical intervention is necessary. At the early stage of aortic illness, as opposed to the prevention and treatment of aneurysms of the cranial aorta by folk diseases, without careless acceleration.

Effective people

Normalize self-esteem for people and make blood-bearing judges more helpful folk aortic aneurysms. Herbal infusions are even more effective and tonic.

• Glid is the most affordable and efficient. More than a long time ago, people have seen the power of the Roslin community. Fruits and leaves to take revenge on helpless important vitamins, important metal that іnshe). Most effective glid in case of heart failure. Now and again, help polish the blood circulation, normalize the grip. To prepare a simple liqueur infusion, it is necessary to add dry berries to the gall (4 tablespoons), pour sprinkles (3 flasks) and let it be infused.
• Anastasia Kalini is an anti-fiery power, struggling with bad luck, as well as cinnamon in case of spasms of sudin and hypertension. The fruit of the flower of the Roslin is to avenge the majesty of Vitamin S, which is necessary for the body, especially, before the hour of becoming ill. In this case, with such a ruptured, like an aneurysm of the cranial aorta, likuvannya folk zobov'yazkovo can include a whole miracle nastiy. Surely, viburnum is not a panacea, but with a complex elimination, it will bring only cinnamon. To prepare an infusion of dry berries, pour sprinkles and insist 3, 5 years.
• Cleanliness - good additional help when struggling with the most common cause of the development of aneurysms - atherosclerosis. Leaves, stems and branches of the growing line hang, and then napolyagayut on sprinkles. Recommended vipivati ​​50 grams infusion.
• Nastiy kropu є not less brown. Cryp with a low grip, assimilating the head beat and beneficially pouring into the heart of the robot. For infusion, you can vikoristovuvat і grass, and nasinnya. 1 tbsp pour sprinkle on the crop (about 200 ml) and infuse for a year. The treatment of aortic aneurysms by folk remedies requires a healthy way of life and a balanced attitude. Slid unique physical, as well as psychological navantages.

Before you start working with a doctor, you need to take a consultation with a doctor.

The information should be pre-eminent in nature and not critical to the point of departure. Do not indulge in self-abuse. At the first symptoms of a disease, it turns to a lykar.

PRAKZHІYUKPGSCHMUEVYAIU

UDC 616.132-007.64-035.7-071

DIFFICULTY І RECEPTIONS IN DIAGNOSTIC Aortic aneurysm

V.I. Dedul, PhD, Associate Professor; I.A. Serafinovich, Candidate of Medical Sciences, Associate Professor

EE "Grodno State Medical University"

The analysis of the reasons for pardons in the diagnosis of aortic aneurysms was carried out. The algorithm for diagnostics of aortic aneurysm in case of adolescence has been broken down. Key words: aorta, aneurysm, rosharuvannya, shudder.

The reasons of diagnostic errors in patients with aorta dissecting aneurysm were analyzed. The algorithm of diagnostic search in the case of suspicion of aorta dissecting aneurysm was worked out. Key words: aorta, aneurysm, dissection, search.

Practical efficiency of a car is not easy to develop with hospitality, Yaki vimagayut secret differential diagnostics. Before them, in the first place, aortic aneurysm (RAA) is introduced.

The aortic enlargement extends to the proximal (viscid aorta obtained) and distal (viscid aorta not obtained) - Fig. 1.

The prejudice of diagnostics of the most dangerous ailment is very difficult. The clinical picture of rosaceous aneurysms in the meaning of the world lies in the localization and length of the process, the stage of healing in the process of going out of the aorta of the arterial vessels, the suppression of the suspected tissues of the bloodstream in the blood. The most important is the variability of the disease and the form of developmental clinical syndromes.

Small. 1. Classification of aortic growth.

problem early diagnostics Aortic enlargement aneurysms are becoming more relevant not only through high mortality, but also tendencies to an increase in the broadening of the pathology. And at the same hour, practical cure for the lack of knowledge of the various illnesses, which will explain the great wealth of differentiation of clinical and pa-tologo-anatomical diagnoses.

Meta robots - detailed early detection of aortic aneurysms.

Materials and methods of presentation

11 years (1993-2003) Among them there were 20 people and 8 women. A retaliatory analysis of the clinical picture of ailment, the introduction of data from laboratory and instrumental methods of pre-treatment (electrocardiographic (EKG), ultrasonic and radiological) and protocols of rosin ailments was carried out.

Aneurysm of the viscous aortic vesicle was diagnosed in 12 ailments, aortic arch

At 2, deciduous viddilu - at 4, cherevny viddilu

At 7. In 3 ailments supravalvular aortic opening was revealed without aneurysm development.

Fatal result of instruction in 25 ailments. All the stench of the pathological and anatomical dosage. In 3 ailments, aneurysm of the viscid aortic appearance of the aorta took a long time. The bezposrednaya cause of death in our spared the emergence of aneurysms in the empty heart shirt (9 ailments), the pleural effusion

Didusiu Vatslav Ivanovich - candidate of medical sciences, associate professor, head. Department of Faculty Therapy Ivan Antonovich Serafinovich - Candidate of Medical Sciences, Associate Professor of the Department of Faculty Therapy

SHUAKTNG KM1U1200M \ 1> VRA CHU

lost (6 ailments), rear middle(3 ailments), to the urea cell (6 ailments), peritoneal empty(1 ailment).

Prevalence of aneurysm was diagnosed in 16 ailments. In reshti ailments pomilkovo transmitted myocardial infarction (5 ailments), thromboembolism legendary artery(3 ailments), the state of destruction of cerebral blood circulation (1 ailment).

The results of that discussion

In the most common picture of the first stage of rosy aneurysms in all types of cases, it is dominated by the pain syndrome. Bіl was victorious rapt in the camp of calmness and only in 4 ailments with a small physical zusilla. Prodromal period buv vidsutniy. Slid means to reach a wide area of ​​pain, tied with the expansion of the aorta wall. Bіl nerіdko (in 78.6% of the ailments) didn’t gnaw only on the chest, but on the back, interscapular space, live, transverse region. Induced irradiation of pain in the shoulder, shoulders, cracks, upper and lower pictures, Grove area. 3 ailments had migraine pain vdovzh spinal stop right up to the transverse area, which is explained by the broadening of the hematoma and the bridging of the aorta. In a large number of individuals (85.7%), they won a ditch, shmatu, baking, and reached the supra-specific intensity. Tsi pains, as a rule, are resistant to bagatorazovyh drugs and neuroleptanalgesia. It is characteristic that the maximum activity of the pain syndrome was indicated on the very cob of the ailment, so that at the time of cutting the inner sheath of the aorta.

Probably our caution. Khvora Sh. 53 years of age entered the surgical department of the 2nd Clinical licenses m Grodno for the direction of the doctor of shvidkoy help with scargs on intensive, "dinghal" bile in the epigastral dilyantsi, Irra-leading to the interscapular space, boring, bagatorazu blues, weak bursting.

Sick Raptovo close 2200 12/13/1993 r Sickness for about a year passed in a nap_vz_gnuty camp (cute dog in the bath). With the sharp expansion of the tuluba, a rapt intolerable beat appeared in sword-like sprout, Yaka nezabarom nabula operative character, feeling like the growth of the line through all the breast and the black empty. Likarem of Shvidkoy supplementary aid was delivered to the surgical clinic with the diagnosis "gostry pancreatitis".

With a stretch of 20 years of suffering from not regularly treated with arterial hypertension III stage, Cukrovym type 2 diabetes, cystic-degeneration Strum.

With a proper fit, the zagalny camp is important. Shkіrnі twist the individuals, we see the mucilaginous Bagri-in-cyanotic colore. Dikhannya 20 in 1 min. The lungs have vesicular dysfunction on the sides. Pulse 90 beats in 1 hour., Tensions, rhythmic. Between the common heart dullness of the oppression in the offense of the side. The width of the bundle of the vessel did not begin with the Chergov lycar. With auscultation of the heart, a muffled tone began, the accent of the first tone over the aorta, bends of a systolic murmur over the heart, which was carried out on the right half of the heart. AT 220/100 mm Hg. Art., does not live blown up, symmetrical, take the fate in the act of dichannya. In the epigastria, with palpation, a sharpness and rigidity of craniality began.

tribute laboratory dosages- without a hundred changes. When radiologic doslіdzhennі showed signs of a gryzhі stravochіdnogo opening of diaphragms with її "utiskom".

On 14.12.93, the upper middle Lapo-Ratom, revision and drainage of the black empty was carried out. Diagnosis of pinched grizzly stravohidny aperture with diaphragms buv vidkinutius. He had a turbulent pain in the area of ​​an operative wound, a backward weakness.

Rizke pogirshennya will come at 1000 12/18/93 r, if the raptus has renewed sharp pain in the breastbone from the collarbone to the left, half of the collarbone, slit, half of the breast, the difficulty of dimming, voice. Signs of the appearance of a birth in liviy appeared pleural emptying... Bula was diagnosed with aneurysm of the thoracic aortic. Diagnosis of confirmations of echocardiography and repeated X-ray diagnostics (enlargement of the aorta, the contour is clear and irregular).

The ailment was transferred to the cardiological class of Vilnyusky University, and resection of aneurysms of the thoracic aortic aorta with prostheses was performed. However, on the 3rd additional operation, a fatal result was obtained.

Variations of the pain syndrome in the thoracic cells in the first place in the first place, the differential diagnosis was carried out with the gostrom myocardial infarction. Most of the ailments with aneurysm of the thoracic aortic aorta and came to the hospital with an adolescent coronary deficiency. In cich vipads, it is necessary to vrahovuvati, if you want, in some cases, in case of myocardial infarction, it can also be raptus, but in the cob period, the ailment is not intense. Bilsh is typical for a

prakvdkUYUKKMMUSVRACHU *

ill health Besides, on the occasion of ailments, who are in an anginal status, ailments during the period of aortic development are not often overwhelmed in the camp of a ruddy illness. With a first painful attack, there was a short-hour lulling, for whom the pains were renewed with great force. The severity and the weakening of the pains were accompanied by a deterioration similar to the process of enlarging the wall of the aorta. Characteristically, most pain in the chest cavity with aortic aneurysm was not supervised by the development of a malignant disability. The arterial grip on the first stage of development of aortic aneurysms is due to the high bulge. Hypotonia developed in case of annoying aortic development. It didn’t mean that the cichs had ailments and who were not safe, but they could prevent drug-induced correction of arrhythmias.

However, it is necessary to remember that in patients with aortic aneurysms, there is a possible and secondary impairment of coronary blood circulation, which was evident in 3 of our ailments. In cychids in the development of myocardial infarction, it is not possible to explain the hematoma of the aorta of the coronal arteries of the heart, since it has developed in 2 ailments with an aneurysm of the cervical viddilu, in 1 ailing lower aneurysm.

Probably our caution. Khvora K. 72 years of age were delivered to the intensive care unit of the 2nd clinical clinic in Grodno at 2225 1.02.96 with scargami on intensive, baking nature of pain in the precordial area, radiating to my handі in the interscapular region, thinning weakness, zamorochennya.

I got sick at 2100 on 1.02.96 r, since there was an unbearable beat at the upper part of the breastbone, feeling a bit of a failure.

With a stretch of 20 rocky in the ailment, the arterial grip grows to high numbers, periodically they turbulently squeeze the character behind the breastbone, regularly DO NOT get caught.

With a proper zagalny stance is important, cyanosis of the lips. Sickness zbujena, throwing himself into a lazhka. The number of podikhiv 20 in 1 min. In the legends, vesicular dichannya, unreasonable wheezing in the lower lateral viddilahs. Heart of the aortic configuration. The width of the vessel bundle did not start. Tony's heart is deaf, arrhythmic, normal-mosistolic form of the atrium. Pulse 56 beats in 1 hour., Arrhythmic, nervous. Pulse deficiency 16 in 1 min. AT 100/60 mm Hg. Art. Lives soft, painless on palpation. Pechinka + 3 cm.

Zagalny analiz blood - without pathology. EKG - atrial atrium, pathological Q wave in III, and "UB, II, U1 - U4. In these cases, the ST segment dome-shaped over the isoelectric line. anterior-lower infarction of the myocardium of the lіvnogo shlunochka, acceleration by cardiogenic shock.

According to the robotic diagnosis, the following drugs are indicated: analgesics, including narcotic, intravenous streptokinase, heparin, rheopolyglucin, dopamine, prednizolone, "polarizing" sum.

Pains in half of the breast cells were of a sickly nature: for 2-3 years they were stopped with a narcotic analgesic, for which they were renewed again. The camp of ailing is progressively degraded. Gallant weakness, galvanizedness has grown. They turned to respect the blat of shkirny crooks, cyanosis of the lips, AT bulo in between 90/55 - 70/40 mm Hg. Art., unvarying on the intravenous dribble, the introduction of a dose of dopamine.

Khvora died at 1100 3.02.96 r on the 2nd day of being transferred to the hospital.

Pathologic and anatomical diagnosis: atherosclerosis - a sharp swelling of the aorta with viral atherosclerotic plaques, arteries of the heart with stenosis and education. Thrombosis of the right vintsevo artery. Gostriy infarction of the myocardium of the anterior-bicardial wall of the right scrotum of the heart. Thrombosis of the splenic artery. Splenic infarction. Sharing of the aorta wall with the development of the newest style on the level of the 10th thoracic ridge. Internal bleeding. Bilateral hemothorax (in the right pleural emptying 1000 mol, in liviy - 1300 ml of fertile blood and clots). Hemoperitoneum (350 ml of fertile blood in the empty blood).

The aortic aneurysm in this vypad is not developed, so as, on the thought of the disease, the clinical picture led to the diagnosis of myocardial infarction.

The expansion of the wall of the aorta can be suppressed by the occlusion of the arteries, which can be seen from the aorta. Before the pain syndrome in cich vipads, there are signs of a deterioration in the blood supply of organs, as they can get shelter through the ciudin. The expansion of the aortic arch can lead to the distribution of blood flow through the sleepy arteries, which causes the development of infarctions in the brain. Such an accelerated pomilkovo bulo was taken for the main disease by one of our ailing, but also a diagnosis was made. In the whole vipadku not boo brutally respect for such

Shua & TIEUUSCHEMRU LIKARIA

the moment, as the development of a neurological symptom-complex on the most severe pains in the chest pathological changes at the EKG.

At the onset of the 2nd stage of aortic aneurysm, the sickness became very sick: there was a symptom of a depression of vital organs, cyanosis in upper half tuluba, zadishka, so є the reason for the emergence of versatile "masks" of a lot of trouble, including the legenevs. So, in 3 of our ailments, the cause of the lethal result was thromboembolism of the legacy artery.

Aneurysm of the cephalic aortic was diagnosed in 7 ailments. All the stench came to the doctor's office with a grave diagnosis. The clinician has the correct diagnosis of the establishment in 5 ailments. In 1 sick person, the correct diagnosis was not made through a short-hour stay in the clinic (less than 1 year). And at the same hour in the second, the correct diagnosis was not made, if the ailment was found in the surgical report 12 days and two were given promptly into the black empty.

Probably our caution. D. Khvoriy, 66 years old, enrolled in the surgical examination of the 2nd clinical medicine in Grodno on October 2, 1993, with scargami on the post-mortem, periodically he had pains in the lower abdomen, dryness in the mouth, spoiled. Ailments stretching out 2 types, if there are similar pains in the lower abdomen, a pure, raw style of green color. For medical aid, I did not kill myself, taking pills and alcoholic drinks (ailments chronic alcoholic). 1.10.93g. buv deliveries to Bilorusia infectsiyna likarnya with diagnostics "gostra kishkova infection". On a friend, I would add a transfer to an infectious clinic at a sick person in the middle of an hour, the pain in the stomach became unbearable. Ailments metavisya through the ward, maghavia vistributi through a window. Surgery of suspected thrombosis of mesenteric vessels, in conjunction with ailments of translations into surgery. Chergov's surgeons and therapists carried out differential diagnosis mіzh abdominal іshemia, Crohn's ailment and hospitality of appendicitis. The link with an unclear diagnosis 10/3/93. in 705, a laparotomy was carried out, with catarrhal changes in the worm-like outgrowth. On the 7th day of the operation, a bullet appeared in the right half of the abdomen with a puffy-like appearance of an unclear progression. 11.10.93 carried out a relaparo-Vacuya, revision of organs of the worms. Bula was diagnosed with a cranial hematoma. check

the day of the drainage of the urea klitkovini. There are a lot of translations before reanimation. The camp of the ailing one is progressively ruined. Zadishka, backward weakness, cough, tachycardia were observed. 13.10.93 Vinyk thrombosis of the pedagogical artery. On the EKG, signs of repeated myocardial infarction were revealed in the lower stage of the cicatricial changes. The blood has neutrophilic leukocytosis due to hypotension, normal-mochromic anemia, and an increase in SHOE. When sowing feces from 1.10.93. have seen Salmonella enteritidis.

Was carried out antibacterial, disintoxication-Zion therapy, transfusion of fresh frozen plasmas, ingibitoriv proteases, anti-anginal drugs were prescribed. Hvory died 10/14/93 RUR

Clinical diagnosis - salmonella sepsis. Diagnostic laparotomy - appendectomy (3.10.93 r). Relaparotomy of the revision of organs of the worms, drainage of the worms (14.10.93 r). Arterial hypertension of the III century, Rizik 4. Atherosclerosis of the aorta. Folding: disseminated intravascular coagulation syndrome. Thromboembolism of hypertension of the leg artery, infarction-pneumonia of the lower part right legends... Thrombosis of the left clavicle artery. Thrombosis of the coronary artery with the development of myocardial infarction of the inferior malignant neoplasms of the louse. Gostra pechinkova lack.

Pathologic and anatomical diagnosis: atherosclerosis of sharp turns with calcification, aortic obstruction, club arteries; stenosing artery of the heart and brain. Aneurysm of the cranial aortic cavity. Right-sided cranial hematoma (mass of blood clots 900 g). Velikovognischeviy myocardial infarction of the lower-bicarial and anterior stinoks of the lynx. Thrombosis of the left stegovaya vein.

In case of bacteriological preliminaries, pathogenic flora was not detected in the place of the small intestine.

The main reasons for the grave diagnosis in this category:

1. Not vrakhovani fonovі malaise - bagatory podvyshennya arterial vise, atherosclerosis of the aorta, chronic alcoholism.

2. Incorrect treatment of pain syndrome in the abdomen.

3. The rate of alertness in patients with aneurysms of the cranial aortic.

4. Reevaluation of the data on bacteriological dosage of feces.

Correct diagnosis of ball-shaped aneurysms and aortic dissection with

PRAKZHAYUUSHOMUVZ & CHU

nya about the particularity of cychs with ailments, the appearance of the background disease, the appearance of the background of the disease (“bagatory development of the arterial vise, atherosclerosis of the aorta, chronic alcoholism), the more common type of situation (the value of the width of the last case of the peripheral tubercle” ), correct interpretation of the EKG changes, fast radiological and ultrasound dosage.

On the basis of a detailed analysis of the peculiarities of the clinical picture, the identification of the reasons for the breakdown of the clinical and pathological and anatomical diagnostics of the breakdowns by us, the algorithm for the diagnosis of a joke at admission to aortic aneurysm.

crazy, cleverly show, Differential diagnostics of rosaceous aneurysms is required for a given vyvchennya, rozrobki and thoroughly.

1. Aortic aneurysm є prognostically unpleasant slowing down a number of illnesses (atherosclerosis of the aorta, arterial hypertension, chronic alcoholism, Marfan's syndrome, etc.).

2. A common reason for the lack of clinical and pathological and anatomical diagnoses є the lack of recognition by practical doctors of the peculiarities of the clinical picture of aortic aneurysms, unreasonable testing of X-ray and diagnostic ultrasound methods.

literature

1. Burov Yu.A., Mikulska Є.G. Possibilities of ultrasound additional-plerography in the diagnosis of atherosclerotic lesions of the aorta and club arteries // Breast and heart-sudinna surgery. - 1998. - No. 6. - S. 40-43.

2. Vinogradov A.V. Differential diagnosis of internal ailments. 3rd ed. add. і revised - M .: TOV "Medical Information Agency", 1999. - 590 p.

3. Gravtsi T.V., Svitlo M.Ya. Clinical options for aortic aneurysms // Clinical medicine. - 1976. - T. 54, No. 11. -Z. 88-91.

4. Dmitriyev V.I. Clinic and diagnostics of rosaceous aneurysms

aorta in especially young and middle age // Vis'kovo-medical journal. - 1980. - No. 4. - S. 48-52.

5. Movsesyan R.A. Surgery of aneurysms of the viscid aorta // Annals of surgery. - 1998. - No. 3. - S. 7-13.

Algorithm for diagnostics of a poke in case of adolescence for aortic aneurysm

Maximum pain syndrome per ear of illness ^

Migratsiya pain in the back of the ridge;

Signs of a hostile livoshlunochkova lack;

Nezpechny arrhythmias, scho vimagayut medicinal corrections;

Arterial vise;

EKG signs of ischemia, disease, necrosis

So So Ni Ni

Nemans

Gostriy INFARKT MIOKARDA

REDUCED RAA

Clarification of factors in risiku (atherosclerosis of the aorta, arterial hypertension, Syphilis in history, chronic alcoholism, nonspecific aortoarteritis, Marfan Syndrome.)

Cycle straightening of the clinical obstruction (the value of the width of the vascular bundle in the 2nd mid-rib, the appearance of pathological murmurs over the aorta, the noise of the peripheral vascular "masks" of the RAA - the asymmetry of the pulse, the appearance of the pulsation of the artery occlusion internal organs) ;

PAA ymovirnist

X-ray of the organs of the breast

Tomography of the middle with targeted aortic obstruction

Ultrasound monitoring of the heart, aorta

Aortography (behind shown)

RAA bring

surgical treatment

conservatively

6. Petrovsky B.V. Exfoliating aneurysm // BMP. - 3rd ed. -

M., 1974. - T. 1. - S. 502-504.

7. Pokrovskiy A.V. Infection of the aorta and її gilok. - M .: Medicine,

8. Senenko A.N., Dmitriev V.I. Spherical aneurysms and discharges

vi aorti // Clinical medicine. - 1978 - T. 56, No. 4. - S. 73-79.

9. Smolenskiy V.S. Aorta ailments. - M .: Medicine, 1964 .-- 420 p.

10. Sprigins D., Chambers D., Jeffri E. Nevidkladna therapy: Practical handbook: Per. from English - M .: GEOTAR Medicine, 2000 .-- 336 p.

DIFFICULTIES AND ERRORS IN DIAGNOSIS OF AORTA DISSECTING ANEURYSM W.I. Dedul, I.A. Serafinovich Grodno State Medical University The clinical, laboratory and instrumental examination methods were analyzed in 28 patients with aorta dissecting aneurysm. The most frequent reasons of diagnostic errors of this disease were revealed and optimal plan of diagnostic search in patients with acute unbearable chest pain was developed.

Aortic aneurysm is a pathological stump that is not safe for life;

It’s more beautiful than the eye, it’s more beautiful, but it’s the aorta? Itself through the aorta, itself great artery, 3 hearts in the fabric and organi to come up with shelter. From the heart, the blood flow through the thoracic fluid reaches the organs, rostashovanim in the central zone. Pass through the diaphragm, at the bottom of it, go to two parts - to the artery clubs, to avoid blood circulation in the lower abdomen, none of the body organs.

Aneurysm is characterized by enlargement and enlargement of the aorta stems as a result of incremental aortic stems. Medical statistics indicate that a cutaneous fourth aneurysm is established in the thoracic cavity. The weakened wall of the aorta does not show a strong grip of blood and inevitably expands. The diameter of the aorta in a normal stani is two centimeters, at that hour the aorta expands from the aortic aneurysm to the size of the aorta, so that it clutters the life of the sick person. Aneurysm can be established in any form, it can stratify or break down. Inevitably, internal bleeding and death are inevitable.

cause

Aneurysm є I will shape the shape aneurysms, scho vinikє through frequent pidvischennya blood vise. Rozsharuvannya velmi not without and seriously obstruct the life of the patient. Yaksho rosharuvannya expands through the entire aorta, to the brain, nirok, kintzivok and other organs ceases to come and shelter.

Nybilsh often given pathology learn from people who are "over 50". The main reason for getting sick is to get into prolonged arterial hypertension. However, the growth of the aorta can be found at the same time on the other side of the pathology. with good fabrics... The great risik of becoming ill and among people, who suffer from the heart and the court system.

Also, the reason for the more beautifully said factor before the development of aneurysms can be the defeat of the aorta by atherosclerosis. Manifest an ailment can і with syphilis. Ridko, ale to develop ailments and morphan syndrome.

In some cases, the aortic stems are expanded after a short insertion of the catheter (in the course of the operation or diagnostics).

development mechanism

Yak to develop for a dane ill? On the cob stage, the patient has a vise, which provokes a strong vise in the aorta. Through a vice, pouring into the wall aorta, there is a stretch, and the inner ball will shrink. Zgodom pіd pouring vise into the roof in the middle ball. The balls grow, and between them a hematoma emerges, as it accumulates with accumulated blood. Farther, the vice can lead to the opening of the aortic sheaths and the last, lethal result.

Falls occur, if the aortic enlargement is seen in a distant straight line. However, it is even faster to place in the proximal strand. With a year of an ailing check, hemopericardium and an important arterial deficiency. This process also provokes the aortic valve and artery occlusion. As a result of shaping, in some cases, repeated tearing of the aortic membrane is observed. As a rule, the winners are lower than that of the first time, deduced from the first place.

manifestation of aneurysms

In medical practice, there are three stages of development of aortic aneurysms. Gostra stadia zvoryuvannya vіdbuvaєtsya stretching out two dib, and the fatal result is most often seen in the first hviliiny, for years when the ear has been expanded.

A subacute stage of three years from two tendencies to the month. Scho feel chronic stage The process of shaping can be trivial in months or in rock. Even at the chronic stage, a shorter version of the development of podіy, oskіlka for a whole hour, a sick person may need a surgical help. At the same stage of fakhivtsi, it is simply not possible to get a chance to help the patient.

symptoms

We will show that a symptom of dissecting aneurysms is infiltrating a sharp pain in the area of ​​the breasts. The ailment is unbearable, unbearable beat, yak from the chest wall to the back. More than that more views do not pry, so that the stench is of a permanent character and in an hour it grows, in case the aorta grows wider. Likewise, people can see a beat in the heart, as they were given a hand. If you feel an arterial grip, then you will be tempted to fall. If I want to trap vipad, if the grip of navpaki, move.

It is also possible to recognize the visibility of symptoms before the symptoms, if the pulse does not appear on the spot. When the aorta is opened, the blood is consumed in the lungs and the bronchi, ailments can be harked with blood. How can I get shelter in a stravohid, spite a crooked blues.

Another symptom of the growth is backwardness, which is indicative of aortic insufficiency. Moreover, at the EHC there are no changes to be made. X-rays, an hour of progression of this pathology, showing the enlargement of aorta, which is spared by stretching out decilkoh days.

With a whole diagnosis, people have little chance, guinea wines mittєvo, or even after a few days. The main cause of death in such diseases is internal bleeding.

accelerating

If the ailments are not covered with a stretch of the first chilin for years, there may be an acceleration at the sight of an insult, myocardial infarction. Besides, it can draw in the functional building of the lower picture, tied to a snarl of blood through the air arteries. Damage to blood flow to the spinal cord and reduction of spinal arteries can damage the function of the spinal cord. Until then, with this illness, there are pains in the area across and across the abdomen, in which case the blood flow in their vessels will be blocked.

We will not be safe and will threaten the life of a sick person, we will get involved in the opening of the aorta and internal bleeding.

diagnostics

In order to diagnose a sick person with digestive symptoms, it is recommended to secretly turn up to fakhivtsiv for medical assistance. For diagnostics of patients' ailments, a set of doslidzhen is used. In the first place, the patient is afraid of the EKG. Slid vrahuvati, scho EHC results do not expect to see the steps of gravity to become ill. Navi as a patient to skarzh for an unbearable bіl, cardiogram may not be able to reveal the hundredths of a change. The male factor is to reduce the development of aortic aneurysms. However, there are drops, if aortic aneurysms are enlarged on the EKG, there is a swelling. In such a situation, there is no evidence of aneurysm due to myocardial infarction.

The directors of the X-ray examination of the organs of the thoracic cells of the fahivtsi can see how the aorta is enlarged and the situation changes.

Another method of diagnostics is ultrasonic examination of the heart, allowing the lectures to know about the camp of the great judges, as well as the heart of the sick. Until then, the ultrasound scan would be able to find the place where it was going.

Examine the thoracic aortic appearance and test the electrocardiography, which helps to assess the degree of atherosclerosis and the size of the aortic valve.

100% visibility or visibility of stratified aneurysms can be performed by computer tomography, as well as magnetic resonance imaging. An MRI scan can help you to get better results.

Phonocardiography allow to assess the noises in the heart of the vessels, as well as to the patients about the manifestation of aortic insufficiency. Another method of advancement is angiography to allow knowledge of the time of development and its length. The Danish method is used to stop the quiet patients who are ready to go to the operation.

The process of diagnostics of aortic aneurysms is foldable, there are a lot of symptoms similar to those of myocardial infarction. staging correct diagnosis It is extremely important, some cases of aortic aneurysm cannot be treated with anticoagulants and thrombolytics, as they are vicious in complex treatment of myocardial infarction.

lykuvannya

It’s important, when the aorta grows out, it’s safe to hospitalize the patient in the hospital, if there’s a new control over vital functions. The process of therapy of this ailment, in the first place, including medications, to speed up the frequency of heart rate and reduce arterial vise... Prior to such drugs include:

Important! Indicators of arterial vise are not guilty of being 100/60 mm Hg.

However, later on, the arterial grip did not become as low as this world, if it is necessary to bring the functions of these organs to the correct level.

The aorta, urazhena in the case of syphilis, in the course of treatment with antibiotics.

The process of lіkuvannya is constantly supervised over time control over the arterial pressure, the frequency of the heart. To control the process of being seen in the aorta, a 12-year-old skin patient should take an x-ray of the breast tissue. The given world is necessary in order to provide the state of affairs to the process. At the state stage, it is not safe to be promptly involved in the region.

For carrying out a termine operation with a given diagnosis, there are a number of indications. Prior to them, it should be mentioned:

1. threat of aortic opening;
2. progressive process of shaping;
3. cover aortic saccular aneurysms.

Promptly involved will inevitably in times, when the administration of medications is ineffective, or more often do not appear.

It is also shown that hemopericardium is involved before the surgical operation, so that if the roof is consumed in the outer shell of the myocardium. The help of surgeries is necessary in case of non-corrosive hypertension, or in other words in the camp, in case of arterial grip of lowering and utrimating on the singing indicators.

Promptly involved in the expansion of the aortic stems, the transfer to the plastic behind the aid of a synthetic prosthesis. Until then, endovascular prosthetics and stent placement are possible. Trivial operation from decilkoh up to six years. If the result of the operation is positive, the patient will be renewed and supported in the hospital for 10 days. With a stretch of days, Lyudin is guilty of taking the preparation, so that she can overcome the tension.

Medical statistics say about those, that 75% of patients with aortic dissection without surgery, die for 14 days.