Case Study: Saving Severe Cardiovascular Patient 病案分析：从命悬一线到转危为安
Case Study: Saving Severe Cardiovascular Patient 病案分析：从命悬一线到转危为安
SEIMC successfully diagnosed and treated a cardiovascular surgical emergency of a patient. 上海东方联合医院成功抢救急诊重症心血管病病人。
At Shanghai East International Medical Center (SEIMC), we believe in the importance of education and knowledge sharing with communities and doctors.
Today, we would like to share the case study of Mr. A so that more people, regardless of age, gender, and current health condition, know that seemingly simple back pains can actually be serious complications; and how we at SEIMC handle life-threatening emergencies. Dr Beng Lin Liam, MD, FRCP Edin, who is chief consultant, family physician and medical director at SEIMC, wrote about Mr. A’s case as below, which not only demonstrated the medical professionalism of himself and SEIMC medical teams but also exemplified the essence of getting to the right hospitals at no waste of a single minute.
Mr. A is the senior executive at a famous international company. Based in Beijing, he came to Shanghai on a business trip in June 2017, when a critical health issue occurred.
One June night, Mr. A was admitted to SEIMC. His back pain started during a business meeting at around 7pm of the same day, lasting for 90 minutes before he was being seen at SEIMC. The pain was initially very severe over the entire upper back for 30 seconds, associated with tiredness, feeling of weakness over his lower body with sweating. There was no shortness of breath, anterior chest tightness or abdominal pain. The said patient’s medical history included Hypertension, Hyperlipidemia and Hyperuricemia, wherein he is on regular medications.
Upon admission, his breathing room air Oxygen Saturation level, blood pressure, and pulse rates，and ECG were normal. The only blood test abnormality found was an elevated D-Dimer。
Upon close review by the staff physicians, the patient was found to have flow murmur at the apex of his heart, lower blood pressure, and weaker peripheral pulses in his left upper limb and right lower limb. A provisional diagnosis of suspected Aortic Dissection was made.
The aorta is the main blood vessel delivering oxygenated blood from the heart to the rest of the body. Aortic dissection occurs with a tear in the inner surface wall of the aorta resulting in bleeding into the wall which separates, narrowing the lumen and obstructing the openings of branch arteries as it extends along the aorta away from the heart.
Our patient had high blood pressure which is a very important acquired predisposing factor for this disease condition. (Aortic dissection is more common in those people with a history of high blood pressure). Stanford Type A Aortic Dissection is a cardiovascular surgical emergency with very high mortality. Urgent ultrasound and Thoracic-Abdominal CT Aortic Angiograms confirmed Stanford Type A Aortic Dissection with false lumen extending from aortic arch in the chest down to iliac artery in the lower abdomen.
A先生有高血压，这是一个非常重要的诱发因素（主动脉夹层在高血压患者中更为常见）。Stanford A型主动脉夹层是一种死亡率极高的心血管外科急症。超声诊断和胸腹部CT主动脉造影亦证实Stanford A型主动脉夹层，并伴有假腔形成从胸主动脉弓延伸至髂动脉。
An immediate cardiovascular surgical referral was made and a surgical team was assembled. Emergency Aortic Arch and Ascending Aortic Grafting Replacement, and Aortic Trunk Stent surgery was performed, in an operation lasting 7-8 hours with Heart-Arterial Bypass. The patient was expected to have postoperative complications of liver and kidney dysfunction and was treated in the intensive care before being transferred to the general ward where he recovered for 2 more weeks before repatriation to his home country.
上海东方联合医院立即安排心脏外科专家团队，为A 先生实施心脏外科手术。在长达8个小时紧急手术中，完成了全主动脉弓替换术、 支架象鼻术和心脏搭桥。病人预计会发生肝肾功能不全的术后并发症。A先生在重症监护室接受治疗两周后，转移至普通病房。 现在A 先生已出院并回国休养。
This case illustrates the successful acute diagnosis and treatment of a Cardiovascular Surgical emergency with very high mortality exceeding 30% even after surgery. His supportive post-operative care during the first 2 weeks after surgery had been really critical to getting him better and out of danger！
SEIMC is well-staffed and equipped to manage this condition if patients come in time, in addition to the more common instances of heart attacks and pulmonary embolism that we encounter.If you are apprehensive about you or your family’s possibility of having heart problems, here are some advices on how you can prevent or earlier detect heart disease symptoms.
Take a tour of hospitals, particularly those with qualified brain imaging facilities and those which can handle and perform high-risk surgeries, to get a feel of the medical environment.
See a cardiological specialist to check your risk factors and talk about heart problems prevention. Keep a record of key personal information including family history, current medications or supplements taken, diet and exercise habits.
Whether or not you have concerns over heart problems, it is always recommended to have annual health checkups to know your general health condition. Call us at 5879-9999 ext. 2662 to know more about our different Health Screening Packages.
Do some tests which can detect heart problems:
Electrocardiogram (ECG) 心电图测试 （ECG）
Blood Tests 血液检查
Holter Monitor 动态监护仪
Cardiac Stress Test 心脏负荷试验
Nuclear Scan 核素扫描
Coronary Catheterization (Angiogram) 冠状动脉导管插入术（血管造影）
Cardiac Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI) 心脏计算机断层扫描（CT）或磁共振成像（MRI）
SEIMC is committed to provide our patients with high level of surgical and post-surgical care. Our surgeons and doctors are supported by a team of internationally trained medical professionals with experience in in-patient and critical care medicine to effectively manage chronic medical conditions or post-operative pain.
The Cardiology Department at Shanghai East International Medical Center offers excellent care for numerous cardiovascular conditions and disorders. Our cardiologists are experts in their field and fluent in both English and Chinese. Many of Shanghai’s cardiology specialists also provide support to our medical center.
Our experienced cardiologists not only provide emergency care for serious cardiovascular conditions, but also provide consultations on cardiovascular disease prevention and routine health checks.
Our team are able to treat the following conditions: 我们的团队提供以下医疗服务
• 24-hour Cardiac Emergencies 24小时心脏急诊
• Lipid Disorder血脂异常
• Pregnancy-related Issues妊娠相关问题
• Coronary Atherosclerotic Disease冠状动脉粥样硬化病
• Valvular Heart Disease瓣膜性心脏病
• Diabetic Heart Disease糖尿病性心脏病
• Refractory Hypertension难治性高血压
• Adult Congenital Heart Disease成人先天性心脏病
• Heart Failure心脏衰竭
• Palpitation and Arrhythmias心悸和心律不齐
• Heart Attack心脏病发作
• Pediatric Heart Issues 儿科心脏问题
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