Chawla Karan, Al-Embideen Somya, Riordan Christopher
University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA.
University of Toledo College of Medicine and Life Sciences; Department of Surgery, Toledo, OH 43614, USA.
Int J Cardiol Cardiovasc Risk Prev. 2023 Jan 20;16:200175. doi: 10.1016/j.ijcrp.2023.200175. eCollection 2023 Mar.
Aortic dissection is a life-threatening condition that classically presents as a sudden, sharp pain with a ripping sensation. This disease is caused by a weakened area within the aortic arterial wall, which can be classified using the Stanford classifications into type A or type B dissections, depending on the location of the tear. It is described that 17.6% of patients died before arriving at the hospital, and 45.2% of patients died within 30 days of diagnosis (Melvinsdottir et al., 2016). However, 10% of patients present without pain, leading to delayed diagnosis. In this case, a 53-year-old male with prior history of hypertension, sleep apnea, and diabetes mellitus presented to the emergency department with complaints of chest pain earlier that day. However, he was asymptomatic on presentation. He had no cardiac history. He was admitted, and a subsequent workup was performed to rule out myocardial infarction. The following morning a slight bump in troponin consistent with a Non-ST Elevated Myocardial Infarction (NSTEMI) was noted. An echocardiogram was ordered and showed aortic regurgitation. This was followed by computed tomography angiography (CTA), which revealed acute type A ascending aortic dissection. He was transferred to our facility and underwent an emergent Bentall procedure. Ultimately, the patient tolerated the surgery well and is recovering. This case is essential because it emphasizes the painless presentation of type A aortic dissection. Mis- or undiagnosed, this condition often leads to death.
主动脉夹层是一种危及生命的疾病，典型表现为突发的、尖锐的、有撕裂感的疼痛。这种疾病是由主动脉壁内的薄弱区域引起的，根据撕裂的位置，可使用斯坦福分类法将其分为A型或B型夹层。据描述，17.6%的患者在到达医院之前死亡，45.2%的患者在诊断后30天内死亡（Melvinsdottir等人，2016年）。然而，10%的患者没有疼痛表现，导致诊断延迟。在本病例中，一名53岁男性，有高血压、睡眠呼吸暂停和糖尿病病史，当天早些时候因胸痛到急诊科就诊。然而，他就诊时无症状。他没有心脏病史。他被收治入院，随后进行了一系列检查以排除心肌梗死。第二天早上，发现肌钙蛋白略有升高，符合非ST段抬高型心肌梗死（NSTEMI）。于是安排了超声心动图检查，结果显示有主动脉瓣反流。随后进行了计算机断层血管造影（CTA），结果显示为急性A型升主动脉夹层。他被转至我们的机构并接受了紧急Bentall手术。最终，患者手术耐受性良好，正在康复。这个病例很重要，因为它强调了A型主动脉夹层的无痛表现。如果误诊或未诊断，这种情况往往会导致死亡。
