Mr. Zhao, a 56-year-old man with hypertension, recently went to the emergency room of a hospital with sudden onset of chest and back pain and measured a blood pressure value of 200/120 mmHg (millimeters of mercury) and an electrocardiogram indicating myocardial ischemia. At that time, the doctor on duty considered it an acute myocardial infarction and treated him with antihypertensive, anticoagulation and thrombolysis. However, half an hour later, Mr. Zhao’s blood pressure and heart rate dropped sharply, and he passed away due to ineffective resuscitation. An autopsy was later performed and it was found that Mr. Zhao was not suffering from an acute myocardial infarction, but from a thoracic aortic coarctation aneurysm. Why would a thoracic aortic coarctation aneurysm cause the patient’s death so quickly? The thoracic aorta is a large blood vessel that emanates directly from the heart, like the main traffic artery in a city; if it has a problem, all traffic associated with it may be paralyzed. If it becomes blocked, has poor blood flow or ruptures and bleeds, it can involve several organs of the body; if it tears and forms a clot, leading to vasodilatation (aneurysm), when extending to the heart, fatal diseases such as myocardial infarction and pericardial tamponade can occur. You could say that a thoracic aortic coarctation aneurysm is like an untimely bomb in the human body. If there is any triggering factor, it may “detonate” and cause serious consequences. The disease starts suddenly and most patients have a clear and brief onset after the onset of the disease. The main manifestations are severe pain, shock and compression symptoms. A few patients die rapidly after the onset due to fatal complications such as cardiac compression (with shock, circulatory failure, etc.), massive bleeding, malignant hypertension, severe aortic regurgitation, and persistent ischemia of the myocardium, central nervous system and kidneys. The morbidity and mortality rate of thoracic aortic coarctation aneurysm within 24 hours of onset is 21% to 25%, with 8% of patients surviving after 30 days and only 1% after 1 year. With the advancement of medical treatment and conditions, the 1-year survival rate has increased to 34%-89%. Do not move during the onset of the disease Once the disease is suspected, the brake should be applied immediately. If it occurs at home, family members should immediately call 120, do not move the patient, and immediately take analgesic and antihypertensive measures to prevent rupture and other complications to gain time for further diagnosis and treatment. Aortic coarctation aneurysm is divided into type A and type B. In the former case, surgical repair is recommended first; in the latter case, because of the high surgical mortality rate (28% to 65%), minimally invasive endoluminal treatment can be adopted. Minimally invasive endoluminal treatment not only makes surgery much less risky, but also helps to improve the natural course of the disease. Currently, endoluminal minimally invasive therapy has become the first-line treatment for aortic coarctation aneurysms. Controlling blood pressure The first 80% of patients with aortic coarctation aneurysms have hypertension. Regardless of whether the patient is treated medically or surgically or with endoluminal minimally invasive therapy during hospitalization, etiology-specific medication and long-term post-discharge antihypertensive therapy (blood pressure should be controlled to below 130/80 mmHg) are essential. A well-controlled blood pressure can greatly prolong the survival time of patients and prevent recurrence. Patients must be treated with lifelong antihypertensive therapy. Even in patients with aortic coarctation with normal blood pressure, it is beneficial to take antihypertensive measures. Studies have shown that the incidence of late rupture of a coarctation aneurysm is significantly higher in patients with poorly controlled blood pressure, almost 10 times higher than in patients with good blood pressure control. Stabilization of atherosclerotic plaques Patients with aortic coarctation aneurysms also have a prevalence of atherosclerosis, which is an important factor in the prognosis of the disease. Therefore, in addition to blood pressure control, patients with aortic coarctation aneurysms should stabilize atherosclerotic plaques, promptly detect any signs suggestive of cardiovascular atherosclerosis, and actively treat them, with specific measures including: ◇Control total dietary calories and eat reasonably. Eat more fiber-rich foods such as vegetables, appropriately supplement foods with high protein content (e.g. milk, fish, etc.), and restrict diets with high fat content. ◇Restrict physical work, but exercise appropriately. Be gradual and should not be forced to do strenuous activities. Promote walking, taijiquan, etc.