Dissecção aguda de aorta como apresentação de emergência hipertensiva

Abstract

, 2008 CASE REPORT A 53-year-old Caucasian male patient from Olimpia, Sao Paulo, with arterial hypertension for 16 years without treatment. He was admitted to the emergency room in October 2006 with sudden, high-intensity chest pain for about 3 hours that had spread to the abdomen and left inferior limb, with hyperhidrosis, palpitations and severe blood pressure elevation. The patient was an alcoholic - 1 bottle of beer per day for 20 years. He denied smoking, diabetes, dyslipidemia and any other previous cardiovascular events. The patient was in good general condition, hydrated, ruddy, cyanotic (2+/4+), eupneic, afebrile, in and out of consciousness. Respiratory auscultation was normal. Cardiac auscultation was rhythmic and normal and without the presence of murmurs. Arterial blood pressure (ABP) was 170 x 110mmHg and heart rate was 86 bpm. The left inferior limb was cyanotic and with a slight loss of sensation. Pulses were not palpable in the femoral and dorsal artery of the left foot. He was monitored and treated with sodium nitroprusside and intravenous metopolol. Upon admission, the patient presented creatine phosphokinase (CPK) 12.589 IU/l, glutamic oxalacetic transaminase (AST) 440U/l, glutamic- pyruvic transaminase (GPT) 148U/L, lactic acid 4.3 mmol/l, ultrasensitive PCR 8.33mg/dl. His glycemia was 133mg/dL and his creatinine level was at 1.4mg/dl. Hemogram showed neutrophils with fine toxic granulations, leukocytosis, relative and absolute neutrophilia and relative leukopenia. Chest radiography and electrocardiogram was normal. Magnetic resonance angiography diagnosed Stanford type B aortic dissection, with hypoperfusion of the anterior portion of the left kidney. Aortography image showed image of double lumen in descending thoracic aorta (Figure 1), successfully treated with Braile Biomedica self-expandable prosthesis (stent) of 34mm in diameter and 90 mm in length (Figure 2).