Headache: an unusual presentation of aortic dissection.

The most common presenting symptom of aortic dissection is chest pain - headache as the initial manifestation is rare. We report a patient with a history of hypertension who presented with severe bifrontal headache, and was found to have an acute aortic dissection in the absence of carotid artery dissection. A discussion of the atypical presentation and possible pathophysiology follows.     

Chronic Aortic Dissection in a Young Adult

Background: Acute aortic dissection is a life-threatening disease that is often a diagnostic challenge in the Emergency Department (ED). Patients with acute aortic dissection often have underlying hypertension and atherosclerotic disease, and commonly present with acute-onset severe chest or back pain in their sixth or seventh decades of life. Aortic dissection, however, can also be seen in patients < 40 years old and may present chronically, with symptom duration longer than 2 weeks. Objective: We present an unusual case of chronic aortic dissection in a young patient, followed by a review of the literature on chronic aortic dissections and aortic dissections in young patients. Case Report: We report a case of chronic aortic dissection in a 32-year-old man with a history of untreated hypertension who presented to the ED with palpitations and mild shortness of breath. Conclusion: Acute and chronic thoracic aortic dissections can occur in patients of all ages, as well as in patients with atypical signs and symptoms.     

Aortic dissection with extension to a patent ductus arteriosus

An 81-year-old woman presented with shortness of breath and fever of 3 days duration. An enhanced CT of the chest revealed a patent ductus arteriosus (PDA) communicating with the true lumen of an aortic arch dissection. Neither the aortic dissection nor the PDA was suspected. The patient had no history of a connective tissue abnormality or other condition which would predispose to dissection other than systemic hypertension. It is likely that propagation of the aortic dissection partially re-opened the ductus arteriosus.     

Emergency repair of aortic dissection in a 37-week parturient: a case report

Aortic dissection is a life-threatening condition with a 50% mortality rate in the first 48 hours and a 3-month mortality rate of 90% in untreated patients. Aortic dissection is a rare complication of pregnancy, but there is significant morbidity and mortality for the mother and infant. A 43-year-old woman with a 37-week intrauterine pregnancy was admitted to the emergency department 6 hours after the onset of tightness in her throat and neck pain. She described the pain as similar to pain she experienced with a myocardial infarction 2 years previously. Other pertinent history included hypertension, gestational diabetes, coronary artery disease, and a family history of aortic dissection. The patient was initially misdiagnosed. Transthoracic echocardio-" gram and computed tomography scan revealed a type A thoracic aortic dissection extending into the abdominal aorta. An emergency aortic repair and cesarean section were successfully performed. Recognition of aortic dissection and an evidence-based, collaborative approach to optimize treatment and recovery are vital to the patient's survival. The purpose of this article is to highlight successful management of aortic dissection in a parturient and to broaden the body of literature on the topic.     

个性化护理干预在二次手术主动脉夹层患者中的应用:附1例报告

回顾分析1例主动脉夹层行血管腔内修复术后二期腔内再干预患者的临床资料,总结其护理方法。此患者高血压病史10年余,未规律治疗,曾因胸主动脉夹层行胸主动脉支架置入术,术后血压控制不佳,18月后复查发现腹主动脉段假腔增大,再次行血管腔内治疗。根据此患者的病情特点,给予个性化的整体护理干预,包括血压管理、疼痛护理、心理护理、预防便秘、预防跌倒及预防并发症等。经过2周的治疗及护理,患者顺利出院,出院后继续给予延续性护理,指导其改善生活方式,完善自我监测,患者目前恢复良好。个性化的整体护理措施,对患者术后的康复有着积极的作用。      

If the bubble bursts.... EMS response to aortic aneurysms & dissections

An aortic disease patient is typically an older male with a history of atherosclerosis and hypertension. He might have Marfanoid characteristics, a history of cocaine or methamphetamine abuse or history of syphilis. Alternatively, suspect dissection in a pregnant female with complaints consistent with possible aortic problems. During your assessment, zero in on the patient's anatomy. Include aortic phenomena in your differential for chest and back pain. Take blood pressures in both arms. Search the abdomen for pulsatile masses, and be wary of hoarseness and Horner's syndrome.     

Headache as the initial manifestation of acute aortic dissection type A

The most common initial symptom of aortic dissection is chest pain. Other initial symptoms include pain in the neck, throat, abdomen and lower back, syncope, paresis, and dyspnoea. Headache as the initial symptom of aortic dissection has not been described previously. A 61-year-old woman with a history of migraine and arterial hypertension developed continuous bifrontal headache. Two hours later, right-sided thoracic pain and a diastolic murmur were suggestive of aortic dissection that was confirmed by echocardiography and subsequent surgery. The dissection commenced in the ascending aorta and involved all cervical arteries until the base of the skull. Headache as the initial manifestation of aortic dissection was assumed due to either vessel distension or pericarotid plexus ischemia. Aortic dissection has to he considered as a rare differential diagnosis of frontal headache, especially in patients who develop aortic regurgitation or chest pain for the first time.     

Acute aortic dissection provoked by sneeze: a case report

The response of the abdominal viscera and the contraction of the intercostal muscles during the respiratory phase of sneezing increases intrathoracic pressure, which may lead to several complications. However, there are no reports in the literature concerning aortic dissection after sneezing. We report a patient in whom the development of dissection was secondary to sneezing, although hypertension was present as a risk factor, and we discuss the relationship between sneezing and aortic dissection. To our knowledge, this is the first report of aortic dissection provoked by sneezing in the literature.     

Sudden death caused by dissecting thoracic aortic aneurysm in a patient with autosomal dominant polycystic kidney disease

Among the fatal vascular complications associated with autosomal dominant polycystic disease (ADPKD), ruptured intracerebral aneurysm and ruptured abdominal aortic aneurysm are widely known. However, there are few reports on the dissecting thoracic aortic aneurysm as a fatal complication of ADPKD. We report a case of a 58-year-old man with a history of ADPKD who presented to the emergency department with out-of-hospital cardiac arrest. Immediate cardiopulmonary resuscitation restored a spontaneous circulation successfully and subsequent image study revealed a type I dissecting thoracic aortic aneurysm. Emergency aortic grafting was performed--but he died from postoperative haemorrhage. The surgical specimen of the aorta showed cystic medial necrosis. This rare case emphasizes the need to consider such a diagnosis in a patient with ADPKD who presents to the emergency department with sudden cardiac arrest. In addition, the histological finding indicates the aetiological role of a collagen defect in addition to chronic hypertension in the pathogenesis of aortic dissection in ADPKD patients.     

Unsuspected embolic fungal endocarditis of an aortic conduit diagnosed by transesophageal echocardiography.

A 66-year-old man with a history of hypertension and ascending aortic replacement because of a type A dissection had 3 successive embolic events (left lower limb, brain, and spleen). Two consecutive transesophageal echocardiography studies showed mobile masses in the ascending aorta. The patient was reoperated without a certain etiologic diagnosis, and an unsuspected fungal endocarditis caused by an unusual germ (Trichoderma species) was found. Transesophageal echocardiography proved very useful in the management of this uncommon case of endocarditis.     

Acute aortic dissection mimicking an acute coronary syndrome through occlusion of the right coronary artery

Occlusion of the right coronary artery (RCA) is an uncommon complication of type A aortic dissection. Aortic dissection and acute coronary syndrome (ACS) share a similar pathogenesis in atherosclerosis and hypertension. Consequently a patient with ischaemic risk factors presenting with chest pain and dynamic ECG change may well be incorrectly treated for ACS if careful attention is not paid to the presenting symptoms and signs. This case report describes a 59-year-old man who presented with chest pain, confusion and an ischaemic ECG and was initially treated for ACS. He subsequently deteriorated clinically and imaging confirmed type A aortic dissection complicated by RCA occlusion. Following emergent surgery with aortic root replacement and coronary artery bypass grafting he later made a good recovery.     

Progress in the diagnosis and management of aortic dissection

A 36-year-old man sought medical attention because of pressure in his head and distention of the veins in his neck. Physical examination disclosed a murmur of aortic insufficiency, and a chest roentgenogram showed a dilated ascending aorta. Two-dimensional echocardiography and angiography demonstrated a large intimal tear in the ascending aorta and aortic insufficiency. The patient underwent a surgical procedure, which revealed that his symptoms were caused by compression of the superior vena cava by the dilated ascending aorta. The aortic dissection was successfully repaired by replacement of the aortic root with a composite graft into which the coronary ostia were reimplanted. After further assessment of the patient, including elicitation of a similar history in some paternal relatives, Marfan's syndrome was diagnosed. Physicians should be aware of the clinical manifestations, pathogenesis, and treatment of aortic dissection. With aggressive treatment, 60 to 90% of patients survived aortic dissection in 1985, whereas only 40 years ago, this entity was rarely recognized premortem or treated successfully.     

Aortic dissection and turner’s syndrome: case report and review of the literature

Cardiovascular abnormalities are frequently encountered in patients with Turner’s syndrome. These include coarctation of the aorta, aortic root dilatation, bicuspid aortic valve, atrial and ventricular septal defects. Aortic dissection is a rare but devastating complication of Turner’s syndrome that usually occurs in adulthood. We report a case of Turner’s syndrome with coarctation of the aorta and chronic aortic dissection, and review the relevant literature. There have been 21 prior reported cases of aortic dissection in patients with Turner’s syndrome. Possible etiologic factors contributing to the occurrence of aortic dissection in this syndrome are protean. They include the presence of cystic medial necrosis, coarctation of the aorta, bicuspid aortic valve, aortic root dilatation, and hypertension, although cases of aortic dissection and Turner’s syndrome have been described in patients without any risk factors. As our knowledge of the natural history of congenital heart defects and risk factors for aortic dissection in Turner’s syndrome is limited, periodic cardiac evaluation of these patients may be warranted. Early recognition and treatment of this potentially lethal complication of Turner’s syndrome is essential.     

Pain characteristics in disease of heart and aorta

Chest pain or discomfort is one of the cardinal manifestations of thoracic diseases. Fast, accurate diagnosis is essential for patients with angina pectoris, acute myocardial infarction, aortic dissection, ruptured aortic aneurysms, and pulmonary embolisms, which have a high mortality if not treated immediately. In patients with ischemic heart diseases and aortic dissection, an accurate history and a chest roentgenogram can serve as helpful guides to their diagnosis, and ultrasound, computed tomography, and electrocardiography can establish the diagnosis. It is important to suspect cardiovascular emergencies based on quality, duration, and location of pain as well as the presents of hypotension or hypertension, and to start these conditions as soon as possible. Then it is necessary to assess the degree of cardiovascular disability and, if necessary, to introduce patients to cardiovascular specialists.     

主动脉夹层31例临床分析

目的提高对主动脉夹层临床特点的认识水平,做到早诊断、早治疗。方法分析31例主动脉夹层的病因、诱因、临床表现、诊断、鉴别诊断及治疗。结果主动脉夹层患者中合并高血压者占80%以上,主要首发症状为突发性撕裂样疼痛,增强CT诊断符合率高(100%)。结论以突发胸痛就诊,尤其有高血压者,必须考虑主动脉夹层的诊断,增强CT是确诊主动脉夹层的首选方法,药物治疗的首要问题是稳定高血压和控制心率,手术治疗是彻底治愈的根本方法。     

Thoracic aortic dissection in an 18-year-old woman with no risk factors

Spontaneous aortic dissection is a rare, life-threatening cause of chest pain, and has a higher prevalence when traditional risks such as age, hypertension, dyslipidemia, or connective tissue disorders are present. However, even in the absence of risk factors, non-traumatic rupture of an aortic dissection may occur. Most are found in patients over 40 years of age. Younger victims of this disease often also suffer from other conditions such as cystic medial necrosis, connective tissue disorders such as Marfan's syndrome, or vasculitis. We present the case of an 18-year-old, previously healthy woman who was country line dancing when she began to complain of severe, cramping chest and back pain. She was hemodynamically stable on initial presentation but experienced two seizures while in the emergency department and was intubated. Subsequently, her blood pressure dropped and she developed cardiac arrest, and despite vigorous resuscitation that included blood products and emergency department thoracotomy, she was refractory to all attempts. At autopsy she was found to have a spontaneous, non-traumatic rupture of an aortic dissection. This patient had no discernable risk factors for aortic dissection or discoverable cause on necropsy. We present this case to raise awareness among physicians and review other reported cases in the literature of aortic dissection in patients under age 40 years.     

Acute Type A Aortic Dissection in a 37-Week Pregnant Patient: An Unusual Clinical Presentation

Background

Aortic dissection in pregnancy is relatively rare, but it is often fatal. The estimated incidence of aortic dissection in the general population is 2.9 per 100,000 person-years. Early recognition and treatment of aortic dissections are crucial for survival. Whereas the majority of patients who present with aortic dissection are older than 50 years of age and have a history of hypertension, younger patients with connective tissue disease, bicuspid aortic valves, or a family history of aortic dissection are also at increased risk for developing this condition.

Thoracic aortic aneurysms

Thoracic aortic aneurysm with dissection is the most common fatal condition involving the aorta. The prevalence of aortic aneurysms appears to be increasing, which may reflect improvements in imaging techniques as well as increased clinical awareness of the condition. Most thoracic aortic aneurysms are caused by atherosclerosis and its associated risk factors of hypertension, smoking, and hypercholesterolemia. The clinical presentation varies and may mimic other more common disease processes. Early recognition on the basis of a focused history, physical examination, appropriate diagnostic studies, and management is essential for good outcomes.     

Stanford B型主动脉夹层118例临床分析

目的 研究Stanford B型主动脉夹层(BAD)患者的临床特征及其对预后的影响.方法 回顾性分析118例患者的临床资料,统计患者的性别、年龄、主诉、既往主要病史、入院时的血压和心率以及住院期间转归.结果 该组病例男性104例,女性14例;平均年龄(52.1±12.9)岁;61.9%的患者有胸痛主诉,71.2%的患者合并高血压病史;入院时平均心率(81.3±14.2)次/min,血压(156.0±34.7/91.9±21.2)mm Hg;入院时收缩压≤100 mm Hg或>160 mm Hg死亡率高(P<0.05);死亡组发病年龄[(41.0±7.8)岁]较存活组[(53.1±12.8)岁]低(P<0.05);入院时心率[(97.1±18.9)次/min]较存活组[(80.0±13.0)次/min]高(P<0.05);总体死亡率7.6%.Logistic回归分析发现,心率和年龄是预测死亡的独立指标.结论 国内BAD患者发病平均年龄52岁.死亡患者平均年龄41岁,较存活组年轻;平均心率97次/min,较存活组快17次/min.收缩压≤100 mm Hg或≤161 mm Hg是死亡的高危人群.     

Racial and Socioeconomic Disparities in the Presence of Acute Type A Aortic Dissections

Nonadherence to hypertensive medications is the most common predisposing factor associated with acute aortic dissections. Acute dissections are more likely to occur in African Americans due to higher rates of uncontrolled hypertension. Through a patient case study, the effects of racial and socioeconomic disparities will be illustrated. Through discussing the case of a 39-year-old African American man who presented with hypertensive crisis and nonadherence to hypertension treatment resulting in the diagnosis of an acute aortic dissection. His case exemplifies the effect of health disparities on postoperative outcomes, morbidity, and mortality in the African American population diagnosed with aortic dissections.