Verma Sameer, Gupta Sameer, Guglin Maya
Department of Cardiology, University of South Florida, Tampa, FL 33618, USA.
Department of Cardiology, University of South Florida, Tampa, FL 33618, USA.
Am J Emerg Med. 2014 Jun;32(6):689.e1-2. doi: 10.1016/j.ajem.2013.12.016. Epub 2013 Dec 12.
Dissection of ascending aorta is a medical emergency typically presenting with acute chest or back pain and hemodynamic instability. We are reporting a very unusual case of dissection of a large ascending aortic aneurysm presenting as a new onset heart failure. A 46-year-old man presented with gradually increasing dyspnea and orthopnea. His physical examination and laboratory findings were consistent with heart failure. The only unusual feature was a diastolic murmur, which prompted echocardiographic evaluation. Besides left ventricular dilatation, hypertrophy, and severe global hypokinesis, which were expected, we also found severely dilated aortic root with aortic regurgitation and a 8.6×9.7 cm ascending aortic aneurysm with dissection. The patient had a brother who died several years earlier from aortic dissection. Surgical treatment was successful. Type A aortic dissection may rarely present as heart failure. Aortic dissection at young age should prompt screening of first-degree relatives because genetic nature of the disease is very likely.
升主动脉夹层是一种医疗急症，通常表现为急性胸痛或背痛以及血流动力学不稳定。我们报告了一例非常罕见的大型升主动脉瘤夹层病例，表现为新发心力衰竭。一名46岁男性出现逐渐加重的呼吸困难和端坐呼吸。他的体格检查和实验室检查结果与心力衰竭相符。唯一不寻常的特征是舒张期杂音，这促使进行超声心动图评估。除了预期的左心室扩张、肥厚和严重的整体运动减弱外，我们还发现主动脉根部严重扩张伴主动脉反流以及一个8.6×9.7厘米的升主动脉瘤伴夹层。该患者有一个哥哥，几年前死于主动脉夹层。手术治疗成功。A型主动脉夹层很少表现为心力衰竭。年轻时发生主动脉夹层应促使对一级亲属进行筛查，因为该疾病很可能具有遗传性质。
