Patient G., 68 years old, entered the therapeutic department of the Clinical Hospital N 5 in Lviv with chest pain complaints increasing when turning the body, occasional headaches and general weakness. The patient has been suffering from hypertension for 10 years; used the antihypertensive drugs sporadically. During the last two days prior to hospitalization the blood pressure (BP) rose to 200/100 mm Hg Art.and the pain in the chest occurred. He was taken to hospital treatment urgently by the ambulance. RW – negative.

Electrocardiography: correct sinus rhythm, 80 in 1 'rejection of electrical heart axis to the left, transition zone in V3.

Ultrasonography of the abdomen and kidneys: signs of cyst in the right hepatic fate. Echocardiography (held twice): the size of the heart chambers are maintained. Disorders of diastolic function of left ventricular type 1. Sclerosis of mitral and aortic valves. Mitral and aortic valves insufficiency is mild. Expanding of the ascending aorta. Ejection fraction is 64 %.

Cardiosurgeon consultation: aneurism expansion of ascending aorta. Hypertension of stage 2. Lack of blood supply – 2A stage. Recommended echocardiography once per every 6–8 months. Observations by a cardiosurgeon.

Despite taking antianginal, antihypertensive medicines (bisoprolol, enalozyd), Antiplatelet agents, proton pump inhibitors (omeprazole), analgesics (analgin injections), the patient kept feeling the intensive chest pain radiating to the thoracic spine, accompanied by a sense of fear, especially at night; the epigastric abdominal pain also appeared. Two days after admission to the hospital body temperature increased to 39 °C. Thus, reasonable doubts about the presumptive diagnosis and diagnosis of osteoarthritis and associated pain appeared. The patient was consulted by ID specialist, urologist, neurologist, cardiologist, but the genesis of chest pain was not clarified. Diagnostic investigation was decided to be prolonged.

Radiography of the thoracic spine: vertebral bodies are of normal shape, locking plates are not changed. The height of the intervertebral discs is stative. Destruction was not found.

Fibrogastroduodenoscopy: On the little curvature in the area of the prepyloric zone erosion was found d 0,2–0,3–0,4 cm with white superimposition. Conclusion: erosive gastritis.

On the 10th day of hospitalization patient’s condition improved: the intensity of chest pain decreased and body temperature got back to normal; BP 135/70 mm Hg Art. However the fear of death at night on a background of pain remained. The patient underwent chest – computed tomography (CT). Conclusion: CT – this test obviously points out to layering aneurysm of the thoracic aorta. Only transesophageal echocardiography gave a clear answer to the conducted investigation: in the lumen of the ascending aorta above the discharge of coronary artery, you can see a peeled off intima. Ascending aorta extended to 48 m.

In cross department aortic arch and descending aorta intramural hematoma was revealed. The diameter of the transverse aortic arch department is 30 mm, descending aorta – 31 mm. In descending aorta, at the level of the left atrium – atherosclerotic ulcer is seen. Significant changes in atherosclerotic abdominal aorta, the maximum diameter of the abdominal aorta is 29 mm. Initial calcification of the fibrous ring of the aortic valve and sclerosis of wings with insufficiency.

The patient was consulted again a month later by heart surgeon and was successfully operated.

Ключові слова: aortic aneurism, blood pressure, fibrogastroduodenoscopy, computed tomography, echocardiography

Повний текст: PDF (Ukr)

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