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Abstract: A 78-year-old grandmother Li came to our hospital with dull head and cerebral tinnitus. She had committed dull head and cerebral tinnitus two days before, but it could be relieved, and this time it persisted without remission, so she came to our hospital. She was diagnosed with aortic atherosclerosis through physical examination and X-ray examination, and was found to have severe aortic lumen stenosis, so she underwent stenting surgery and treatment with injectable cefoperazone sodium sulbactam sodium, atorvastatin calcium tablets and nifedipine tablets, and her condition was stable after treatment.
Basic information】Female, 78 years old
Type of disease】Aortic atherosclerosis
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of consultation】February 2021
Treatment plan】Surgical treatment (arterial stenting) + intravenous infusion (cefoperazone sodium sulbactam sodium for injection) + oral medication (atorvastatin calcium tablets, nifedipine tablets)
Treatment period】5 days of inpatient treatment, 1 month back to the hospital for review after discharge
Treatment effect】Dullness of head and tinnitus disappeared, aortic stenosis was lifted, and aortic atherosclerosis was stabilized.
I. Initial consultation
The 78-year-old grandmother Li came to our hospital accompanied by her family. She had symptoms of dull head and persistent tinnitus when she woke up two days ago, and today she had dull head and tinnitus again, which could not be relieved. I measured her blood pressure and found a large differential pulse pressure and a significantly elevated high pressure at the level of grade III hypertension, suspecting severe aortic stenosis. An urgent x-ray was performed to determine aortic calcification, suggesting the presence of atherosclerosis and severe luminal stenosis, which could lead to a severe shortage of blood supply to the brain, resulting in persistent symptoms of dullness and cerebral tinnitus. He was admitted to our hospital as “aortic atherosclerosis”.
II. Treatment history
After the diagnosis of aortic atherosclerosis, we discussed with Grandma Li and her family about stenting surgery for treatment, and they agreed. After puncture, an arterial sheath was placed, and the sheath was used to extend the contrast catheter and guidewire into the aorta, and then the site of severe stenosis was further defined by retracting the contrast catheter and guidewire and extending the guidewire and guiding catheter, and then the stent was placed into the severe stenosis along with the guidewire. The stent was then placed into the severe stenosis along the guidewire. After the operation, she was pushed back to the ward and given intravenous cefoperazone sodium sulbactam for injection to prevent surgical incision infection. In view of the presence of hyperlipidemia and hypertension in Grandma Li, excessive lipid and blood pressure may lead to aggravation of aortic atherosclerosis, so she was discharged with atorvastatin calcium tablets to control lipid and nifedipine tablets to lower blood pressure. For chronic obstructive pulmonary disease, it is recommended to refer to the department after the treatment is completed.
III. Treatment results
Through the operation of the action vein stenting and postoperative prevention of wound infection with cefoperazone sodium sulbactam sodium for injection, after the operation, Grandma Li’s complaints of head dullness and cerebral tinnitus disappeared after she woke up, and the physical examination revealed that the blood pressure returned to normal. After X-ray examination, it was found that the aorta was no longer stenosed. After 5 days of hospitalization, Grandma Li’s surgical incision was completely healed and she was considered to be discharged from the hospital. After discharge, she came to the hospital for monthly review. No aggravation of aortic atherosclerosis was found through X-ray examination, and the lumen was in good condition, and she complained of good physical condition.
IV. Precautions
After receiving arterial stenting and postoperative application of cefoperazone sodium sulbactam sodium for injection to prevent surgical incision infection, the aortic stenosis was corrected, which is a happy thing, but for Grandma Li, she still needs to take atorvastatin calcium tablets and nifedipine tablets regularly after discharge to control blood lipids and blood pressure to avoid aggravation of aortic atherosclerosis. And in general, high oil and salt foods should be avoided. Due to her age and slow gastrointestinal recovery after anesthesia, Grandma Li also needs to eat easily digestible foods such as millet porridge and pumpkin porridge to reduce the gastrointestinal burden after discharge. If any physical discomfort occurs after discharge from the hospital, it is necessary to return to the hospital to consult the doctor to avoid delaying the treatment.
V. Personal insight
Grandma Li’s aortic atherosclerosis is so severe that the size of the atherosclerotic plaque increases and eventually the aorta will be severely obstructed. It is a good thing that Grandma Li consulted a doctor promptly when she became unwell, so as to avoid more serious damage caused by continuous lack of blood supply to the brain. In addition, the cause of the aggravation of aortic atherosclerosis is mostly considered to be the presence of hyperlipidemia and hypertension, so it is especially important to adjust the life and diet habits, otherwise the aortic stenosis may also recur.