Dangerous! A 51-year-old man suddenly had severe abdominal pain, and it turned out to be "aortic dissection"!

Recently, the Emergency Medicine Department of Hunan Second People's Hospital (Provincial Brain Hospital) admitted a 51-year-old middle-aged man who complained of sudden severe upper abdominal pain within half an hour. The pain felt like a sharp knife stirring his internal organs, and cold sweat instantly soaked his shirt. His friends thought he had "acute gastroenteritis" and rushed him to the emergency department.

When Dr. Zeng Hao examined the patient, he found that the blood pressure was as high as 210/110 mmHg. The severe abdominal pain accompanied by such high blood pressure was definitely not a simple symptom of gastroenteritis. An emergency abdominal CT + thoracic and abdominal artery CTA was performed, and the results showed that it was Stanford type B aortic dissection with intramural edema. The blood D-dimer was as high as 12.79 ng/ml, which further confirmed the diagnosis of aortic dissection.

Zhou Qibing, director of the emergency medicine department , said that about 35% of patients with aortic dissection first visit the gastroenterology department. When we talk about "abdominal pain", we should not only be alert to gastrointestinal, liver and gallbladder lesions, but also realize that this may be an ultimatum from blood vessels.

1. What is aortic dissection?

If the largest blood vessel in the human body (the aorta) is compared to a three-layer rubber water pipe, aortic dissection is a sudden crack in the inner membrane of the water pipe. High-pressure blood rushes into the middle of the blood vessel wall, tearing the blood vessel into two real and fake cavities - just like the wall skin bulges and falls off after being damp, and the whole wall may collapse at any time.

What's so scary about aortic dissection?

First, blood vessel rupture: high-pressure blood flow may instantly burst blood vessels, causing massive bleeding (fatal within a few minutes);

Second, organ starvation: the torn vascular membranes may block the branches that supply blood to the heart, brain, and intestines (causing stroke, intestinal necrosis, etc.).

2. Diagnostic trap: "vascular assassin" disguised as stomach pain

Deceptive camouflage: Just like a chameleon can disguise itself as a branch, aortic dissection sometimes masquerades as "stomach pain". When many patients are ill:

- I thought I had a stomachache and just lay in bed with a hot water bottle in my arms;

- Went to the gastroenterology department for gastroscopy and liver and gallbladder examination, which wasted time in vain;

- The doctor may also be confused and prescribe painkillers and stomach medicine first, not realizing that the blood vessels are quietly tearing.

Why is it hard to find?

1. Initially, it is like a normal stomachache: At first, it may just be a dull pain, which is no different from the stomachache after eating hot pot;

2. It is easy to go to the wrong door during the examination: just like looking for a thief but checking the wrong room, or gastroscopy/B-ultrasound can't find vascular problems;

3. Fatal complications are hidden deep: When blood vessels are torn and affect the blood vessels supplying the intestines, abdominal pain will suddenly intensify (the intestines may have already suffered from lack of oxygen and necrosis).

3. How to treat it?

1. The first step to save lives

Rapid diagnosis, do not delay in "checking stomach problems". If you have sudden upper abdominal pain like a knife, immediately perform a vascular CT scan. Secondly, be alert to "blood pressure difference": measure the blood pressure of the left and right hands at the same time. If the difference exceeds 20mmHg (for example, 160/100 on the left hand and 130/80 on the right hand), it is likely to be an alarm for blood vessel tearing.

2. Surgery

① Minimally invasive stent placement (commonly used): a small hole as big as a pen tip is made at the base of the thigh, and the folded stent is sent to the ruptured blood vessel, and then it is opened and plugged (similar to using a patch to seal a crack in a water pipe). You can get out of bed 2-3 days after the operation.

② Major open-chest surgery (in severe cases): If the tear is close to the heart, the thoracotomy is required to remove the damaged blood vessels and replace them with artificial blood vessels (recovery after surgery will take more than 1 month).

③Key points after surgery: Prevent "water pipes from leaking again": You may need to take antihypertensive drugs for life after surgery (control blood pressure below 130/80). Regular follow-up: Do a vascular ultrasound every six months to check whether the stent is displaced or bleeding.

4. How to prevent it?

1. Controlling blood pressure is a top priority

- Hypertensive patients: measure blood pressure regularly every day (once in the morning when you wake up and once before going to bed).

- Eat less salt: no more than 5 grams of salt per day (about one beer bottle cap), and eat less pickles, bacon, and soy sauce.

- Don’t get too emotional: Take a deep breath for 10 seconds before arguing with someone. Sudden anger can cause your blood pressure to soar by 50%!

2. Be gentle in your daily actions

- Three steps to getting up: lie down with eyes open for 30 seconds → sit up for 30 seconds → let your legs hang down for 30 seconds and then stand up (to prevent a sudden rise in blood pressure).

- Avoid exerting force suddenly: Do not exert force suddenly when lifting heavy objects or when you are constipated (imagine your blood vessels as balloons, which will cause them to "bulge" if you use too much force).

3. High-risk groups should be screened

- People with long-term high blood pressure, smoking, and obesity: have a carotid artery ultrasound (a "mirror" of the degree of vascular aging) done once a year.

- People with family genetic diseases (such as Marfan syndrome): Regular cardiac ultrasound examinations should begin during adolescence.

Zhou Qibing, director of the emergency medicine department , finally reminded that the aorta is like a three-layer rubber tube, and high blood pressure is like constantly pumping air into the tube. When the inner rubber layer ages (arteriosclerosis) or is congenitally weak (genetic disease), the high-pressure airflow (blood) will push out a layer on the tube wall - just like a bulging bicycle tire that may burst at any time. Timely repair can avoid the tragedy of car crashes and deaths.

Remember: any tearing, persistent abdominal pain is your body's cry - "Please give me a chance to check my blood vessels!"

Hunan Medical Chat Special Author: Zeng Hao, Department of Emergency Medicine, Hunan Second People's Hospital (Provincial Brain Hospital)

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(Edited by YT)