Cardiovascular Emergency in an Old Man with Epigastralgia

Image Cardiovascular Emergency in an Old Man with Epigastralgia qA 77-year-old man experienced with epigastralgia, cold sweating and syncope at home, and then he visited our emergency room (ER).On physical examination, the patient appeared weakness and clear consciousness.His vital signs were pulse 77 beats per minute, blood pressure 118 over 76 mm Hg.The abdomen showed mild tender over epigastric area.Blood tests showed mild anemia with hemoglobin of 11.2 g/dl, platelet count of 15600/mL, and creatinine level: 1.1 mg/dL.Plain abdomen film showed a large calcified mass in the abdomen at left paravertebral of low lumbar spines (Fig. 1A).For further evaluation, the emergent abdominal computed tomography (CT) was performed and showed fusiform dilatation of the abdominal aorta (about 10 cm in maximal diameter), focal irregularity and contrast medium extravasation in the lower abdomen (Fig. 1B).The patient received emergent operation with endovascular stent-graft and intensive care unit (ICU) care; he recovered eventually and was discharged on Day 11.The mortality rate of ruptured abdominal aortic aneurysm (AAA) is about 41% to 50%, and it is directly associated with the timeliness of diagnosis and surgical intervention, and most delays