Background. Aortic dissection is one of the leading causes of death in cardiovascular disease. The clinical course of aortic dissection is often atypical and can mimic a variety of clinical manifestations. Stroke is one of the conditions that can make the management of aortic dissection becoming more complex. Case presentation. A 55-year-old female patient came with complaints of severe chest pain. The patient was diagnosed with Stanford aortic dissection, De Bakey type II, hypertension heart disease, mild mitral regurgitation, mild circumferential pericardial effusion. After the second day of treatment, the patient also complained of sudden slurred speech and weakness on right extremities. The administration of antiplatelet were postponed in consideration of the current patient with aortic dissection. On the 7th day of treatment, the patient experienced a worsening motor strength on the right extremities. We decided to continue antihypertensive therapy on acute phase of ischemic stroke with the consideration that aortic dissection can cause higher mortality. Conclusions. The management of ischemic stroke in a patient with aortic dissection is challenging. In ischemic stroke patient with aortic dissection, anti-hypertensives need to be given to reduce the stress on the aortic wall and prevent expansion of the dissection which has a higher mortality rate.
Introduction: Smoking has been associated with morbidity and cardiovascular events. Administration of antioxidants can prevent aortic calcification and reduce levels of atherosclerosis markers caused by cigarette exposure. Andrographis paniculata, with the main ingredient of Andrographolide, has antioxidant, anti-inflammatory and effects on the cardiovascular system. Methods: This study is an experimental study with a randomized post-test control group design to determine the effect of Andrographis paniculata extract on aortic abnormalities in rats. Samples were randomly divided into two groups: the control group, which was given standard feed and exposure to cigarette smoke, and the treatment group, which was given standard feed, exposure to cigarette smoke, and Andrographis paniculata extract. Results: TLR4 expression in the control group (mean 41.50 ± 4.17), the first treatment group (mean 30.75 ± 3.24), the second group (mean 15.25 ± 3.01), the third group (mean 9.75 ± 4.65). The Shapiro Wilk normality test showed that the data were normally distributed (P > 0.05) with homogeneous data variance (P > 0.05). The analysis was continued with One Way Anova and found a significant difference between groups (P = 0.000). The aortic calcification in control group (mean 1.80 ± 0.616 pixel percentage); group 1 (means1.00 ± 0.48 pixel percentage), group 2 (mean 0.54 ± 0.34 pixel percentage), group 3 (mean 0.24 ± 0.16). In the Shapiro Wilk normality test, all data of aortic calcifications were normally distributed (P > 0.05) with inhomogeneous data variance (P < 0.05). The analysis continued with One Way Anova, and there were significant differences between groups (P = 0.001). Conclusion: Giving Andrographis paniculata extract to rats exposed to cigarette smoke decreased TLR4 expression and reduce the incidence of aortic calcification. Keywords: Andrographis paniculata, calcification, TLR4.
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