Painless Aortic Dissection

Painless aortic dissection (PAoD) has been previously linked to poor outcomes. We recently encountered a case of a patient with PAoD presenting with dyspnea; the clue to diagnosis was the presence of a loud aortic diastolic murmur. A systematic review of the literature revealed 86 other cases, 62% o...

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Published inThe American journal of the medical sciences Vol. 354; no. 5; p. 513
Main Authors Marroush, Tariq S, Boshara, Andrew R, Parvataneni, Kesav C, Takla, Robert, Mesiha, Nancy A
Format Journal Article
LanguageEnglish
Published United States 01.11.2017
Subjects
Aged
Aneurysm, Dissecting - diagnosis
Aneurysm, Dissecting - drug therapy
Aneurysm, Dissecting - mortality
Aneurysm, Dissecting - pathology
Female
Humans
Male
Middle Aged
Heart failure
Stroke
Dissection
Aortic
Painless
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Summary:Painless aortic dissection (PAoD) has been previously linked to poor outcomes. We recently encountered a case of a patient with PAoD presenting with dyspnea; the clue to diagnosis was the presence of a loud aortic diastolic murmur. A systematic review of the literature revealed 86 other cases, 62% of which occurred in men with a mean age of 65 years. Left-sided neurologic deficits were the most common presentation, followed by dyspnea and bilateral lower extremity deficits. Pulse asymmetry was found in 53% of patients, as 29% had right-left asymmetry and 24% had upper-lower asymmetry. Cumulatively, 88% of the cases were type A dissection and 51% of the patients died. Erroneous application of fibrinolysis and anticoagulation occurred in multiple instances. PAoD is rare but potentially fatal; a high index of suspicion and a thorough cardiovascular examination are needed to establish the diagnosis before applying possible harmful interventions such as fibrinolysis, vasodilation or anticoagulation.
ISSN:1538-2990
DOI:10.1016/j.amjms.2016.11.005