Background- The definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma(IMH) continue to be debated. Methods and Results- We studied 1010 patients with acute aortic syndrom...Background- The definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma(IMH) continue to be debated. Methods and Results- We studied 1010 patients with acute aortic syndromes who were enrolled in the International Registry of Aortic Dissection(IRAD) to delineate the prevalence, presentation, management, and outcomes of acute IMH by comparing these patients with those with classic aortic dissection(AD). Fifty- eight(5.7% ) patients had IMH, and this cohort tended to be older(68.7 versus 61.7 years; P< 0.001) and more likely to have distal aortic involvement(60.3% versus 35.3% ; P< 0.001) compared with 952 patients with AD. Patients with IMH described more severe initial pain than did those with AD but were less likely to have ischemic leg pain, pulse deficits, or aortic valve insufficiency; moreover, they required a longer time to diagnosis and more diagnostic tests. Overall mortality of IMH was similar to that of classic AD(20.7% versus 23.9% ; P=0.57), as was mortality in patients with IMH of the descending aorta(8.3% versus 13.1% ; P=0.60) and the ascending aorta(39.1% versus 29.9% ; P=0.34) compared with AD. IMH limited to the aortic arch was seen in 7 patients, with no deaths, despite medical therapy in only 6 of the 7 individuals. Among the 51 patients whose initial diagnostic study showed IMH only, 8(16% ) progressed to AD on a serial imaging study. Conclusions- The IRAD data demonstrate a 5.7% prevalence of IMH in patients with acute aortic syndromes. Like classic AD, IMH is a highly lethal condition when it involves the ascending aorta and surgical therapy should be considered, but this condition is less critical when limited to the arch or descending aorta. Fully 16% of patients have evidence of evolution to dissection on serial imaging.展开更多
Cardiac tachyarrhythmias have rarely been studied in young patients with myotonic dystrophy type 1 (DM1). The authors observed major cardiac rhythm disturbances in 11 patients aged 10 to 18 years. Tachyarrhythmic even...Cardiac tachyarrhythmias have rarely been studied in young patients with myotonic dystrophy type 1 (DM1). The authors observed major cardiac rhythm disturbances in 11 patients aged 10 to 18 years. Tachyarrhythmic events were more frequent than impulse conduction disorders. Wide variations in CTG expansion were observed among the population. Since physical exercise was a prominent arrhythmogenic factor, systematic exercise tests with EKG monitoring may be indicated in young patients with DM1.展开更多
1 病历报告患者,男,23岁.因车祸致胸部外伤后疼痛,胸闷憋气,心悸1 d急症入院.体格检查:脉搏85次/min, 呼吸20次/min,血压85/60 mm Hg(1 mm Hg=0.133 kPa),头颈部无异常,胸廓无畸形,胸骨体压痛,双肺呼吸音粗,双肺底闻及少许湿啰音.心前...1 病历报告患者,男,23岁.因车祸致胸部外伤后疼痛,胸闷憋气,心悸1 d急症入院.体格检查:脉搏85次/min, 呼吸20次/min,血压85/60 mm Hg(1 mm Hg=0.133 kPa),头颈部无异常,胸廓无畸形,胸骨体压痛,双肺呼吸音粗,双肺底闻及少许湿啰音.心前区可触及震颤,心界向左下扩大,心率120次/min,律不齐,心尖部闻及4～6级收缩期杂音,向左腋下传导,胸骨左缘第2肋间闻及2～6级收缩期杂音,肺动脉第2心音亢进,脉搏短绌,腹部无异常,肝脾不大,双下肢无水肿.展开更多
胶囊内镜检查为临床诊断提供了方法,胶囊滞留虽不常见,但可能引起严重后果,本院收治胶囊内镜滞留食道1例患者,现报道如下。1临床资料患者,女,64岁。因间断黑便3年余、再发2周收入本院,患者轻微活动后感心悸、气促、胸闷等,既往有高血压...胶囊内镜检查为临床诊断提供了方法,胶囊滞留虽不常见,但可能引起严重后果,本院收治胶囊内镜滞留食道1例患者,现报道如下。1临床资料患者,女,64岁。因间断黑便3年余、再发2周收入本院,患者轻微活动后感心悸、气促、胸闷等,既往有高血压、高心病、心房纤颤及2型糖尿病病史。入院查体:一般情况及精神可,血压150/75 mm Hg(1 mm Hg=0.133 kPa),双肺未见明显异常,心尖搏动位于左側第五肋间锁骨中线外1 cm,心界左下扩大,心律绝对不齐,心音强弱不等,脉搏短绌,心率101次/分,三尖瓣区可闻及全收缩期吹风样杂音。展开更多
文摘Background- The definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma(IMH) continue to be debated. Methods and Results- We studied 1010 patients with acute aortic syndromes who were enrolled in the International Registry of Aortic Dissection(IRAD) to delineate the prevalence, presentation, management, and outcomes of acute IMH by comparing these patients with those with classic aortic dissection(AD). Fifty- eight(5.7% ) patients had IMH, and this cohort tended to be older(68.7 versus 61.7 years; P< 0.001) and more likely to have distal aortic involvement(60.3% versus 35.3% ; P< 0.001) compared with 952 patients with AD. Patients with IMH described more severe initial pain than did those with AD but were less likely to have ischemic leg pain, pulse deficits, or aortic valve insufficiency; moreover, they required a longer time to diagnosis and more diagnostic tests. Overall mortality of IMH was similar to that of classic AD(20.7% versus 23.9% ; P=0.57), as was mortality in patients with IMH of the descending aorta(8.3% versus 13.1% ; P=0.60) and the ascending aorta(39.1% versus 29.9% ; P=0.34) compared with AD. IMH limited to the aortic arch was seen in 7 patients, with no deaths, despite medical therapy in only 6 of the 7 individuals. Among the 51 patients whose initial diagnostic study showed IMH only, 8(16% ) progressed to AD on a serial imaging study. Conclusions- The IRAD data demonstrate a 5.7% prevalence of IMH in patients with acute aortic syndromes. Like classic AD, IMH is a highly lethal condition when it involves the ascending aorta and surgical therapy should be considered, but this condition is less critical when limited to the arch or descending aorta. Fully 16% of patients have evidence of evolution to dissection on serial imaging.
文摘Cardiac tachyarrhythmias have rarely been studied in young patients with myotonic dystrophy type 1 (DM1). The authors observed major cardiac rhythm disturbances in 11 patients aged 10 to 18 years. Tachyarrhythmic events were more frequent than impulse conduction disorders. Wide variations in CTG expansion were observed among the population. Since physical exercise was a prominent arrhythmogenic factor, systematic exercise tests with EKG monitoring may be indicated in young patients with DM1.
文摘1 病历报告患者,男,23岁.因车祸致胸部外伤后疼痛,胸闷憋气,心悸1 d急症入院.体格检查:脉搏85次/min, 呼吸20次/min,血压85/60 mm Hg(1 mm Hg=0.133 kPa),头颈部无异常,胸廓无畸形,胸骨体压痛,双肺呼吸音粗,双肺底闻及少许湿啰音.心前区可触及震颤,心界向左下扩大,心率120次/min,律不齐,心尖部闻及4～6级收缩期杂音,向左腋下传导,胸骨左缘第2肋间闻及2～6级收缩期杂音,肺动脉第2心音亢进,脉搏短绌,腹部无异常,肝脾不大,双下肢无水肿.
文摘胶囊内镜检查为临床诊断提供了方法,胶囊滞留虽不常见,但可能引起严重后果,本院收治胶囊内镜滞留食道1例患者,现报道如下。1临床资料患者,女,64岁。因间断黑便3年余、再发2周收入本院,患者轻微活动后感心悸、气促、胸闷等,既往有高血压、高心病、心房纤颤及2型糖尿病病史。入院查体:一般情况及精神可,血压150/75 mm Hg(1 mm Hg=0.133 kPa),双肺未见明显异常,心尖搏动位于左側第五肋间锁骨中线外1 cm,心界左下扩大,心律绝对不齐,心音强弱不等,脉搏短绌,心率101次/分,三尖瓣区可闻及全收缩期吹风样杂音。
