Severe stenosis of the descending thoracic aorta

Introduction When the thoracic aorta is stenosis, the increase in blood pressure is due to an increase in vascular volume above the stenosis and plasma renin activity (the plasma renin activity assay refers to the determination of plasma renin activity. The renin-angiotensin system mainly includes: renin, Angiotensinogen, angiotensin, aldosterone. Renin is mainly produced, stored and secreted by the proximal cells of the kidney. The angiotensinogen is mainly caused by the increase of the liver.

Cause

Common causes are atherosclerosis, cystic degeneration of the arteries, syphilis, congenital, traumatic and infectious. Among them, arteriosclerosis is the most common cause.

an examination

Related inspection

ECG dynamic electrocardiogram (Holter monitoring)

Balloon dilatation is the treatment of thoracic aortic stenosis (aortic stenosis, which refers to aortic valve disease due to rheumatic, congenital malformation, aging of the valve structure, etc., resulting in limited aortic valve opening. As the lesion progresses A simple, safe, and effective method for clinical triads of aortic stenosis: fatigue, dyspnea, angina, and syncope.

Differential diagnosis

First, multiple arteritis

The typical clinical manifestations of multiple arteritis are not difficult to diagnose, but atypical patients need to be differentiated from other diseases. Any young person, especially a woman who has more than one of the following manifestations, should be suspected or diagnosed.

1. Ischemic symptoms appear in unilateral or bilateral limbs, accompanied by weakened or disappeared arterial pulsations, decreased blood pressure or undetectable or bilateral limb pulse pressure difference greater than 1.33 kPa (10 mmHg) or lower limb systolic blood pressure lower than upper limb systolic blood pressure less than 2.67 kPa (20mmHg) (same width cuff).

2. Cerebral ischemia symptoms, accompanied by unilateral or bilateral carotid pulsation weakened or disappeared and neck vascular murmur. However, some people, due to increased pulse pressure or increased heart rate, can hear mild vascular murmurs in the right neck, and should be differentiated from pathological murmurs according to the following characteristics: 40 years old, especially female, and appear Typical symptoms and signs for more than a month, limbs or brain.

3. Recent high blood pressure or refractory hypertension, accompanied by high-level vascular murmurs above the upper abdomen.

4. Not obvious low fever, rapid blood sedimentation, accompanied by abnormal changes in vascular tone, limb pulse or blood pressure. Can involve the pulmonary artery or coronary artery caused by the corresponding clinical manifestations.

5. There is no change in the fundus.

Second, aortic valve narrow

Most patients with aortic stenosis are adults, with no history of rheumatism, and often find heart murmurs during physical examination. Because of the strong compensatory capacity of the left ventricle, there may be no symptoms in the clinic or only complaints are prone to fatigue. These patients are referred to as asymptomatic aortic stenosis. As the disease progresses, symptoms gradually appear. When the left ventricular end-diastolic pressure rises, breathing difficulties occur during exercise, and the head is dizzy. However, during the period of time, the left atrial systolic blood pressure is increased due to the increase of heart rate after exercise. The heart discharges blood, so the above symptoms are relatively stable. Once the symptoms such as fainting and angina after exercise appear, it indicates that the condition has deteriorated.

Third, patent ductus arteriosus

The arterial catheter is a blood vessel that communicates between the pulmonary artery and the descending aorta in the fetal blood circulation. It is located between the root of the left pulmonary artery and the isthmus of the descending aorta. The normal state is closed more than shortly after birth. If it fails to close, it is called patent ductus arteriosus. The symptoms of patent ductus arteriosus depend on the thickness of the catheter, the size of the sub-flow, the level of pulmonary vascular resistance, the age of the patient, and the combined intracardiac malformations. In full-term infants, although the catheter is large, it takes 6-8 weeks after birth, and symptoms appear after the pulmonary vascular resistance decreases. Premature babies have fewer pulmonary arteriolar smooth muscles and lower vascular resistance, so they can have symptoms in the first week, often with shortness of breath, tachycardia and acute dyspnea. It is more obvious when breastfeeding, and is prone to colds, upper respiratory tract infections, pneumonia, etc.

Since then, the child has been compensated, rarely have self-conscious symptoms, but poor development and thin body. Some children are prone to fatigue and guilt after only being tired. Patients with moderately sized catheters are generally asymptomatic, and symptoms of decompensation of heart function such as shortness of breath and palpitations do not occur until after intense activity in their 20s. Pulmonary hypertension can occur below 2 years of age, but the obvious signs of pulmonary hypertension are mostly older, showing dizziness, shortness of breath, and hemoptysis. After the activity, the hairpin (more than half of the body is obvious). If complicated with subacute endocarditis, there are systemic symptoms such as fever, loss of appetite, and sweating. Endocarditis rarely occurs in childhood, but is more common in adolescence.

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