Mr. Wang is 40 years old, a mid-level leader of a company, and is in the rising stage of his career. On this day, he suddenly felt severe pain in the chest, breathing difficulties, the situation was very critical, his family rushed him to the hospital. He died on the next day after the doctors failed to rescue him urgently. Shanghai Changhai Hospital Vascular Surgery Department Jing Zaiping family grief, but also puzzled, young, for good reason how to go away? Through the family’s confession, we found that Mr. Wang had chest pain symptoms two years ago, but all because of a quick recovery, he also did not care. The cause of chest pain is more, we will be the “killer” probably locked in the aortic coarctation, thoracic aortic aneurysm, angina and coronary heart disease on this type of vascular disease. After visiting colleagues in Mr. Wang’s unit, we were further informed that Mr. Wang was a strong social worker, a smoker and a drinker, and a “meatless” person. Preferring tobacco and alcohol, but also love meat, which is likely to cause the accumulation of a lot of “vascular waste” in the blood vessels. But what is the specific disease? The forensic autopsy found that the patient had a small amount of grayish yellow or grayish white plaque residue in the aorta. What exactly are these residual traces? Did they cause Mr. Wang’s death? And what was the cause of death? We invited Professor Jing Zaiping, the famous founder of endoluminal angiology and director of vascular surgery at Changhai Hospital of the Second Military Medical University, to assist us in the analysis of this “vascular” case. Professor Jing carefully observed the “crime scene”, and then combined with the autopsy report of the forensic pathologist, finally concluded that Mr. Wang died of a rupture of the aortic coarctation. Professor Jing told us that the human blood vessel wall has three layers, which are divided into inner membrane, middle membrane and outer membrane from the inside out. Under normal circumstances, these three layers are tightly bound together like a “triple splint”. Once the intima ruptures due to certain conditions, blood flow will rush from the rupture into the middle layer of the aortic wall, leaving only a thin outer layer of the vessel wall. Therefore, after aortic coarctation is formed, the most fatal thing is the rupture of the wall – if the outer membrane cannot withstand the rushing blood flow, the vessel ruptures like a river breaking its banks and blood spurts freely in the body, killing the patient within minutes. Aortic coarctation is therefore also known as the “untimely bomb” in the human body. During the investigation, Professor Jing found that it was the shedding of these “grayish yellow or grayish white plaques” two years ago that caused the rupture and shedding of the lining of the vessel wall, causing the aortic coarctation and laying the scourge. Finally, the explosion of the “untimely bomb” led to Mr. Wang’s death. Although Mr. Wang died of aortic coarctation, the culprit behind it, and the key to solving the case, is precisely those “gray-yellow or gray-white plaques”. “I have long been aware of these latent scourges,” said Professor Jing Zaiping, “and countless people have been unknowingly killed by them, and their scientific name is atherosclerosis!” Atherosclerosis refers to the deposition of a layer of lipid-like material on the arterial wall, which results in a decrease in the elasticity of the arterial wall and a narrowing of the lumen. High fat intake and lack of exercise and other lifestyle changes are the most important causes of atherosclerosis of the arteries. Mr. Wang is a “good drinker” and “meatless”, so with the excessive intake of cholesterol and high-energy food, the cholesterol level in the blood rises, and cholesterol cannot be removed in time, leading to its gradual deposition on the intima of blood vessels, and atherosclerosis occurs silently. Sclerosis, until the disease is very serious, and ultimately too late to regret. Atherosclerosis is an ancient disease, and atherosclerotic lesions were found in the arteries of Egyptian mummies 500 years ago. With the development of modern society and the continuous improvement of people’s living standards, atherosclerosis disease “rejuvenated” and has now become the “first killer” of human health. How does this “killer” “work”? With the help of Prof. Jing Zaiping, we focus on the process of its “operation” – the first step: “lurking” – “burrowing” into the blood vessels. The first step: “lurking” – “burrowing” into the blood vessel wall. Some diseases or poor lifestyles, such as high blood pressure, diabetes, smoking, etc., can easily cause the inner lining of blood vessels to break down. Excess cholesterol in the blood, mainly LDL cholesterol, “burrows” into the vessel wall through the broken vessel lining and is slowly deposited, “lurking” in the vessel, waiting for an opportunity to “commit a crime The second step: “brewing”. The second step: “brewing” – deposition into plaque. Cholesterol deposited in the walls of blood vessels causes a chronic inflammatory response in the walls of blood vessels, combined with many impurities in the blood, forming a substance medically known as “atheromatous plaque”. This is called atherosclerosis because of the yellowish appearance of the plaque to the naked eye, which resembles millet porridge. These plaques adhere to the walls of the blood vessels, just like the scale of the water pipes, so that the lumen of the blood vessels gradually become narrow, “stupid”, brewing “crime” time. The third step: the “crime” – the vascular event. There are two kinds of atheroma: stable plaque and unstable plaque. Stable plaque is deposited for a long time and not easy to fall off, so the body has enough time to form side branch circulation for blood supply, and only when the lumen narrowing exceeds 70%, angina and cerebral ischemia will occur. Unstable plaque is like a dumpling with big filling and thin skin, which is a time bomb. Under the stimulation of work tension, staying up late or heavy smoking, the plaque will suddenly rupture and fall off. If the fallen plaque happens to tear the intima of the vessel, it will cause vascular diseases such as aortic coarctation and aortic aneurysm. If the blood does not break through the intima, platelets and other substances will immediately coalesce at the rupture and quickly form a blood clot. The dislodged plaque then flows throughout the body with the blood flow and becomes blocked at small vessels (such as coronary arteries and cerebral arteries), leading to acute myocardial infarction and cerebral infarction. The milder ones have a stroke and paraplegia, while the more serious ones die. Professor Jing said that these wanted “vascular killers” are good at roaming “crime”: flee to the lower limbs, inducing leg infarction; flee to the heart, inducing heart attack; flee to the brain, inducing brain infarction. The danger is so great that it is outrageous! Professor Jing cautioned in a serious way that atherosclerosis “favors” smokers, and various plaques mostly occur in men aged 35 to 50 who smoke a lot, causing them to die young! Just like Mr. Wang in the case, it’s a sigh of relief! And the elderly are their “favorite” object, because the elderly blood vessels aging, prone to atherosclerosis. If it occurs in the heart aortic valve, causing valve calcification, more will cause heart aortic valve stenosis disease! Understanding the “first killer” of the “crime” process and “crime” target, we can target prevention and treatment, such as reasonable diet, quit smoking and limit alcohol, moderate exercise. In serious cases, we need to actively use medication under the guidance of a vascular surgeon to prevent it from taking advantage of the situation. There are a lot of clinical cases that prove that many patients do not seek medical attention when aortic coarctation occurs for the first time, but choose to live with it, and at this time the “untimely bomb” has already been planted, and there will be no room for recovery in the next attack! Therefore, Professor Jing suggests that, in addition to good habits, if chest pain like Mr. Wang’s occurs and you cannot tell whether it is aortic coarctation or other vascular disease, you should go to the hospital to “report” it as soon as possible to avoid another tragedy! (This article was published in Shanghai Senior News on January 21, 2016)