A case of aortic dissection without severe chest pain during an attempt at epidural anesthesia

1999 ◽  
Vol 13 (3) ◽  
pp. 185-186
Author(s):  
Ritsuko Fukuda ◽  
Masayuki Okada ◽  
Sumio Amagasa ◽  
Yoshihide Miura ◽  
Hikaru Hoshi ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Epidural Anesthesia ◽  
Severe Chest Pain

Sudden death due to aortic dissection in early pregnancy – a case report

2017 ◽  
Vol 85 (3) ◽  
pp. 162-164 ◽  
Author(s):  
Akshith RS Shetty ◽  
YP Girish Chandra ◽  
S Praveen ◽  
Somusekhar Gajula
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Sudden Death ◽  
Aortic Dissection ◽  
Early Pregnancy ◽  
First Trimester ◽  
Ascending Aorta ◽  
Severe Chest Pain ◽  
Rule Out

Forensic pathologists come across many deaths due to natural causes which are sudden. Sudden natural deaths in females who are pregnant warrant thorough investigation and a medico-legal autopsy to rule out any foul play. Here, we report a case of 21-year-old primigravida in her first trimester who suddenly complained of severe chest pain and was brought dead to the hospital with no history suggestive of prior natural disease. At autopsy, the death was attributed to dissection of ascending aorta.

scholarly journals Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Watanabe ◽  
H Yoshino ◽  
T Takahashi ◽  
M Usui ◽  
K Akutsu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Back Pain ◽  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Diagnostic Markers ◽  
Network Database ◽  
History Of ◽  
First Contact

Abstract   Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P<0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P<0.001), history of hypertension (73% vs. 58%, P<0.001), SBP ≥150 mmHg (39% vs. 22%, P<0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P<0.001), and back pain with SBP <90 mmHg (4.5% vs. 0.1%, P<0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P<0.001), dyslipidaemia (17% vs. 42%, P<0.001), and history of smoking (48% vs. 61%, P<0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P<0.001), back pain with SBP <90 mmHg (OR 68, 95% CI 16–297, P<0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P<0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs <90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively. In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP <90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain. Funding Acknowledgement Type of funding source: None

AORTIC DISSECTION: WHEN CHEST PAIN IS NOT ACS

2017 ◽  
Vol 33 (10) ◽  
pp. S216
Author(s):  
L. Poirier ◽  
K. Then ◽  
T. VanZalingen
Keyword(s):  
Chest Pain ◽  
Aortic Dissection

scholarly journals Severe chest pain with mid-ventricular obstruction in a patient with hyperthyroidism

2017 ◽  
Vol 34 (1) ◽  
pp. 128-131
Author(s):  
Jong Ho Nam ◽  
Jang Won Son ◽  
Geu Ru Hong
Keyword(s):  
Chest Pain ◽  
Severe Chest Pain

scholarly journals Diagnóstico precoce de dissecção aórtica em pacientes com dor torácica: uma revisão integrativa da literatura

2021 ◽  
Vol 10 (2) ◽  
pp. e28110212542
Author(s):  
Olívio Joaquim Fonseca Neto ◽  
Isabella Pires Gomes Mendes ◽  
Andressa Carvalho Pereira ◽  
Juliano Luiz de Souza ◽  
Brenda Larissa Andrade Viana ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Google Scholar

Introdução: A Dissecção Aórtica Aguda (DAA) é definida como uma súbita ruptura da camada íntima da aorta, expondo a camada subjacente ao fluxo sanguíneo e criando um “falso lúmen” paralelo à parede aórtica. A DAA é um agravo extremamente letal e que requer rápida identificação para iniciar o tratamento cedo e evitar a morte do paciente. Esta revisão teve como objetivo descrever as principais manifestações clínicas da DAA e apresentar estratégias para a identificação precoce e eficiente desse agravo no departamento de emergência. Métodos: Foi realizada uma revisão integrativa de estudos publicados nas plataformas PubMed e Google Scholar com os descritores: “aortic dissection” AND “chest pain”. Foram selecionados 37 artigos, 12 foram excluídos e 25 estudos foram utilizados na revisão. Resultados e Discussão: Para diagnóstico precoce, além de análise de sinais e sintomas, podem ser úteis na investigação exames complementares como radiografia, tomografia computadorizada, ressonância magnética, ecocardiografia, eletrocardiograma, ultrassonografia cardíaca focalizada (FOCUS) e exame de sangue incluindo enzimas cardíacas. Conclusão: Os estudos analisados possibilitaram o entendimento patológico da DAA, bem como a apresentação de formas eficientes de diagnóstico e de tratamentos do agravo.

Aortic dissection in children and young adults: diagnosis, patients at risk, and outcomes

2003 ◽  
Vol 13 (4) ◽  
pp. 341-344 ◽  
Author(s):  
Eli Zalzstein ◽  
Robert Hamilton ◽  
Nili Zucker ◽  
Samuel Diamant ◽  
Gary Webb
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Medical Condition ◽  
Young Patients ◽  
Diagnostic Tools ◽  
Cardiac Defects ◽  
Congenital Cardiac Defects ◽  
Ischemic Bowel ◽  
Presenting Symptoms

Objective: To heighten the awareness of pediatricians and pediatric cardiologists to aortic dissection, a potentially dangerous medical condition. Methods: We reviewed the charts of 13 patients, seen in four medical centers, who suffered acute or chronic aortic dissection over the period 1970 through 2000 whilst under the age of 25 years. Results: There were seven male and six female patients, with the mean age at diagnosis being 12.1 years, with a range from one day to 25 years. Congenital cardiac defects were present in five patients, and Marfan syndrome in four. In three of the patients with congenital cardiac defects, aortic dissection developed as a complication of medical procedures. In three patients, dissection followed blunt trauma to the chest. We could not identify any risk factors in one patient. The presenting symptoms included chest pain in four patients, abdominal pain and signs of ischemic bowel in two, non-palpable femoral pulses in one, and obstruction of the superior caval vein in one. Angiography and magnetic resonance imaging were the main diagnostic tools. Overall mortality was 38%. Only six patients had successful surgical outcomes. Conclusion: Due to the rarity of aortic dissection a high index of suspicion is required to reach the diagnosis in a timely manner. It should be considered in young patients complaining of chest pain in association with Marfan syndrome, anomalies of the aortic valve and arch, and chest trauma.

scholarly journals P190 Chest pain and syncope in Turner"s syndrome: going beyond the obvious to not miss the critical diagnosis. Role of multimodality imaging approach

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Ruocco ◽  
M Previtero ◽  
N Bettella ◽  
D Muraru ◽  
S Iliceto ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pericardial Effusion ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Dissection ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Rule Out ◽  
Typical Chest Pain

Abstract Clinical Presentation: a 18-year-old woman with Turner’s syndrome (TS), with history of hypothyroidism treated with L-thyroxin, asymptomatic moderately stenotic bicuspid aortic valve (AV) and without any known cardiovascular risk factor, was admitted to our emergency department (ED) because of syncope and typical chest pain after dinner associated with dyspnea. Chest pain lasted for an hour with spontaneous regression. In the ED the patient (pt) was normotensive. An ECG showed sinus rhythm (88 bpm), nonspecific repolarization anomalies (T wave inversion) in the inferior and anterior leads. Myocardial necrosis biomarkers were negative. A 3D transthoracic echocardiography showed normal biventricular systolic function with left ventricular hypertrophy, dilatation of the ascending aorta, unicuspid AV with severe aortic stenosis (peak/mean gradient 110/61 mmHg, aortic valve area 0,88 cm2-0,62 cm2/m2), mild pericardial effusion (Figure Panel A, B, C). Five days after, the pt had a new episode of typical chest pain without ECG changes. A computerized tomography (CT) was performed to rule out the hypothesis of aortic dissection and showed a dilation of the ascending aorta and pericardial effusion localized in the diaphragmatic wall, no signs of dissection or aortic hematoma. However, CT was of suboptimal quality because of sinus tachycardia (120 bpm) and so the pt underwent a coronary angiography and aortography that ruled out coronary disease, confirmed the dilatation of ascending aorta (50 mm) and showed images of penetrating atherosclerotic ulcer of the ascending aorta (Figure panel D). The pt underwent urgent transesophageal echocardiography (TOE) that confirmed the severely stenotic unicuspid AV and showed a localized type A aortic dissection (Figure Panel E, F, G). The pt underwent urgent AV and ascending aorta replacement (Figure Panel H). Learning points Chest pain and syncope are challenging symptoms in pts presenting in ED. AV pathology and aortic dissection should be always suspected and ruled out. TS is associated with multiple congenital cardiovascular abnormalities and is the most common established cause of aortic dissection in young women. 30% of Turner’s pts have congenitally AV abnormalities, and dilation of the ascending aorta is frequently associated. However, unicuspid AV is a very rare anomaly, usually stenotic at birth and requiring replacement. The presence of pericardial effusion in a pt with chest pain and syncope should raise the suspicion of aortic dissection, even if those symptoms usually accompany severe aortic stenosis. Even if CT is the gold standard imaging technique to rule out aortic dissection, the accuracy of a test is critically related to the image quality. When the suspicion of dissection is high and the reliability of the reference test is low, it’s reasonable to perform a different test to rule out the pathology. Aortography and TOE were pivotal to identify the limited dissection of the ascending aorta. Abstract P190 Figure.

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