One night in the summer of 2011, Mr. Li, who lives in Baoding, went for a drive on the Ring Road after drinking with some friends. When he was having a good time, Mr. Li suddenly felt a heartbreaking pain in his chest and back, and his friends saw him in pain and quickly took him to the hospital. The hospital doctor did a series of tests for him, including an electrocardiogram suggesting a myocardial infarction in the lower wall of the heart. Combined with Mr. Li’s history of coronary heart disease and hypertension, the doctor made a preliminary diagnosis of “acute inferior wall myocardial infarction”. After the targeted treatment, Mr. Li’s pain did not ease, but began to have difficulty breathing, and the pain expanded to the abdomen, and the electrocardiogram did not have the dynamic evolution of the infarction during the treatment process, and there was no significant elevation of cardiac enzymes, so obviously, the diagnosis of “myocardial infarction” was probably wrong. At this moment, the air in the observation room of the emergency room seemed unusually tense, then pancreatitis, gallstones, gastric perforation and other surgical emergencies were ruled out one by one, the consulting doctors proposed to perform cardiac ultrasound, and soon the ultrasound suggested that the ascending aorta was widened and had intimal separation. The mysterious killer that came to the forefront was finally seen, and after the confirmation of enhanced CT, the doctors finally locked the culprit – aortic coarctation. If the aortic coarctation is compared to a raging mystery killer, then hypertension is the main manipulator behind the scenes. Hypertension is the most important factor in the development of aortic coarctation, and statistics show that 70%-80% of aortic coarctation is caused by hypertension. The aorta is composed of three layers of structure, from the inside to the outside, which are the inner membrane, the middle membrane and the outer membrane. Mr. Li usually suffers from hypertension, and drinking alcohol will drive the blood pressure higher, and the intima is easily torn. Once the intima is torn, blood flows between the intima and the epima, forming a local false lumen in mild cases, and in severe cases, the false lumen can involve the whole aorta (see figure). If the blood pressure is too high or the activity is intense, causing the rupture of the outer membrane, the blood in the false lumen will be in a flood and the patient will have little chance of survival. This is just like a big army, the defense line is broken or not broken between a line, the defense of the territorial integrity, but can not prevent the loss of the country, if the patient does not receive timely treatment, the mortality rate of 25% within 24 hours, 50% within 48 hours, 70% within a week, aortic coarctation is really fierce as a tiger! The aortic coarctation is mysterious because it is very good at covering itself, Mr. Li was initially misdiagnosed as “myocardial infarction of the lower wall of the heart”, and then was suspected of pancreatitis, gallstones, etc. It is evident that the diagnosis of the disease has gone through a very tortuous process. This is because the means of attack for aortic coarctation are very varied, for example, compression of bronchus by false lumen can cause respiratory distress, compression of branch vessels can cause ischemia in their blood supply organs, and the cause of Mr. Li’s abdominal pain can be intestinal ischemia due to compression of superior mesenteric artery by false lumen. Coupled with the lack of awareness and vigilance in diagnosing the disease, the clinical doctor would have considered lung or abdominal disease more often, and this is how aortic coarctation was muddled, ultimately leading to irreparable results. Mr. Li was lucky that 6 hours after the onset of the disease, the doctor immediately recommended transferring to a higher hospital for treatment after the enhanced CT confirmed the diagnosis. Based on Mr. Li’s physical condition, the doctor at the higher hospital recommended endoluminal repair, which is the so-called endoluminal repair refers to the application of a laminated stent to seal the endothelial rupture of the vessel, thus achieving the purpose of treatment. Compared with the traditional open-heart surgery, endoluminal repair has the advantages of small trauma, high safety and fast recovery after surgery. The scar indicates that Mr. Li is healed, and also tells that a thrilling life-threatening battle was performed here. Mr. Li was saved, but many such patients were not. We learned the hard way that although aortic coarctation is as fierce as a tiger, it can still be prevented. For the main manipulator behind the scenes – hypertension, we should actively prevent hypertension, low salt and low fat diet, less alcohol and no smoking, more sports, not to create conditions for the disease to breed; if suffering from hypertension, take medication on time, reasonable diet, regular medical checkups, these good habits can keep aortic coarctation out of the door.