Headache as the Initial Manifestation of Acute Aortic Dissection Type A

Cephalalgia ◽  
1998 ◽  
Vol 18 (8) ◽  
pp. 583-584 ◽  
Author(s):  
C Stöllberger ◽  
J Finsterer ◽  
C Fousek ◽  
FR Waldenberger ◽  
H Haumer ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Initial Symptom ◽  
Thoracic Pain ◽  
Initial Manifestation ◽  
Initial Symptoms ◽  
Rare Differential Diagnosis ◽  
History Of ◽  
Diastolic Murmur ◽  
Base Of The Skull

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 be considered as a rare differential diagnosis of frontal headache, especially in patients who develop aortic regurgitation or chest pain for the first time.

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

scholarly journals P881 Young patient with left ventricular hypertrophy and accidentally discovered aortic dissection: hypertensive heart or hypertrophic cardiomyopathy?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Gawor ◽  
M Franaszczyk ◽  
E Kowalik ◽  
M Spiewak ◽  
I Michalowska ◽  
...  
Keyword(s):  
Chest Pain ◽  
Hypertrophic Cardiomyopathy ◽  
Aortic Dissection ◽  
Troponin T ◽  
Global Longitudinal Strain ◽  
Interventricular Septum ◽  
Positive Family History ◽  
Left Ventricular ◽  
Jugular Veins ◽  
Rare Differential Diagnosis

Abstract A 36-year-old male with positive family history of sudden cardiac death (his uncle"s son died suddenly at the age of 25), hospitalized a month ago in a local hospital due to acute hypertensive cardiogenic pulmonary edema, was referred to our institution for further evaluation with suspicion of hypertrophic cardiomyopathy. On admission patient was asymptomatic, without fatigue, exertional dyspnoea, chest pain or syncope. On physical examination his BP was significantly elevated (180/100 mmHg). The lungs were clear on auscultation, liver was not enlarged, jugular veins were normal, there was no oedema of lower extremities. Abdominal auscultation revealed vascular murmur in umbilical region. The baseline level of NT-proBNP was 811.4 (range 0–125) pg/mL, and high-sensitivity cardiac troponin T was 20.2 (range 0–14) ng/L. The standard 12-lead electrocardiogram demonstrated sinus rhythm, left atrial enlargement and left ventricular (LV) hypertrophy with nonspecific ST segment and T-wave changes (Fig. 1A). No significant pathology was present on chest X-ray (Fig. 1B). Transthoracic echocardiography revealed significant concentric LV hypertrophy with preserved LV ejection fraction (EF 70%) and moderately decreased global longitudinal strain (GLS-13.7%). There was mild dilatation of left atrium. Ascending aorta diameter was in normal range (Fig. 1C-D). Cardiac magnetic resonance (CMR) scan confirmed concentric LV hypertrophy with the maximal wall thickness of 18 mm at interventricular septum, and increased myocardial mass (LV mass index 124 ml/m2, range 59–92). Moreover, small areas of late gadolinium enhancement were found in LV segments (Fig. 1E-F). Due to presence of vascular murmur in abdomen, ultrasound imaging was performed. The exam revealed abdominal aortic dissection (Fig. 1G-H). Patient was transferred to the computed tomography (CT) unit to confirm the diagnosis. Aortic dissection originated below renal arteries and involving common illiac arteries was detected (Stanford B). The presence of thrombi within the lumen created by the aortic dissection suggested chronic presentation. Patient was managed conservatively with strict blood pressure control and close follow up arranged. We decided to perform genetic analysis. Currently we are awaiting the results in hope that it will help us to establish the diagnosis and differentiate hypertensive heart from hypertrophic cardiomyopathy. In conclusion, aortic dissection typically presents with tearing chest pain and severe hemodynamic compromise. Painless dissection, like in this case, is relatively rare. Differential diagnosis between hypertensive heart and hypertrophic cardiomyopathy is crucial as it has direct therapeutic impact. Abstract P881 Figure 1

scholarly journals Localized Aortic Dissection in a Patient with Polycystic Kidney Disease: A Case Report

2021 ◽  
Vol 6 (04) ◽  
pp. 285-287
Author(s):  
Sarah A. Alkuraydis ◽  
Abdulaziz S. Allihimy ◽  
Osama Smettei ◽  
Rami M Abazid
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Chest Pain ◽  
Uncontrolled Hypertension ◽  
Polycystic Kidney ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
The Right ◽  
Multiple Cysts

Aortic dissection (AD) is the most frequent life-threatening aortic disorder. It is commonly associated with hypertension; however, aortic dissection occasionally represents a complication of more complex syndromes. In this article we aim to report. A 40-year-old male patient, with a known case of ADPKD and a strong family history of ADPKD. He presented to the emergency department with prolonged sharp retrosternal chest pain radiating to the back and uncontrolled hypertension. Computed tomography angiography showed a localized dissection flap at the aortic root and multiple cysts in the right kidney. AD is a life-threatening condition and should be suspected in patients presenting with acute chest pain with history of ADPKD.

Chest pain

2015 ◽  
Author(s):  
Hugo Farne ◽  
Edward Norris-Cervetto ◽  
James Warbrick-Smith
Keyword(s):  
Acute Coronary Syndrome ◽  
Oral Contraceptive ◽  
Chest Pain ◽  
Aortic Dissection ◽  
Older People ◽  
Oral Contraceptive Pill ◽  
Contraceptive Pill ◽  
Coronary Syndrome ◽  
Combined Oral Contraceptive ◽  
History Of

A good way to come up with a list of causes is to visualize the anatomy of the affected area and think of what could go wrong. Thus, in chest pain, there may be pathology of the heart, aorta, lungs, pulmonary vessels, oesophagus, stomach, thoracic nerves, thoracic muscles, or ribs. The main causes of acute chest pain in an individual aged over 60 include are listed in Figure 9.1. A younger patient is less likely to be suffering from diseases of old age, such as: • Acute coronary syndrome • Stable angina • Myopericarditis (usually post-infarction) • Thoracic aortic dissection • Thoracic aortic aneurysm A younger female patient on the combined oral contraceptive pill is more likely to be suffering from: • PE (the combined oral contraceptive pill is thrombogenic) • Pneumothorax (especially if tall and thin) • Cocaine-induced coronary spasm (still rare, but particularly unusual in older people). The following diagnoses require immediate management and should be kept in mind: • Acute coronary syndrome (unstable angina, or myocardial infarction (MI)) • Aortic dissection • Pneumothorax • PE • Boerhaave’s perforation The key features of each are listed below. 1 Features of acute coronary syndrome ■ History of sudden-onset, central, crushing chest pain radiating to either/both arms, neck or jaw, usually lasting a few minutes to half an hour (longer if there is ongoing infarction). Have a higher index of suspicion in those with a previous history of angina on exertion or MI and/or cardiovascular risk factors (smoking, hypertension, hypercholesterolaemia, diabetes mellitus, family history). ■ Signs of hypercholesterolaemia: cholesterol deposits in small skin lumps on the back of the hand or bony prominences like elbows (xanthomata), in creamy spots around the eyelids (xanthelasma), or a creamy ring around the cornea (arcus). Note that arcus is a normal finding in older people. ■ Signs of peripheral (atherosclerotic) vascular disease: weak pulses, peripheral cyanosis, cool peripheries, atrophic skin, ulcers, bruits on auscultation of carotids. ■ Signs of brady- or tachyarrhythmia. An arrhythmia is relevant for two reasons.

scholarly journals Syncope as the Initial Manifestation of Advanced Nasopharyngeal Carcinoma: A Case Report

2022 ◽  
Vol 8 ◽  
Author(s):  
Si-Cheng Zhang ◽  
Mao-Qing Lin ◽  
Li-Wei Zhang ◽  
Xue-Qin Lin ◽  
Man-Qing Luo ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Carotid Sinus ◽  
The Elderly ◽  
Initial Symptom ◽  
Initial Manifestation ◽  
Carotid Sinus Syndrome ◽  
Positron Emission ◽  
Nasopharyngeal Biopsy ◽  
History Of

Carotid sinus syndrome is a principal cause of syncope in the elderly. Syncope, associated with carotid sinus syndrome which is secondary to metastasis of advanced nasopharyngeal carcinoma, rarely occurs. The current study reported a 66-year-old woman, who presented with a history of frequent and recurrent syncope as the initial symptom, and was eventually diagnosed with advanced nasopharyngeal carcinoma. The positron emission tomography scan demonstrated a diagnosis of advanced nasopharyngeal carcinoma with involvement in carotid sheath space, and nasopharyngeal biopsy revealed non-keratinized nasopharyngeal carcinoma. After diagnosis and treatment, the patient had no recurrence of syncope. In summary, our case study suggests that great importance should be attached to potential intrinsic causes of syncope especially in the case of nasopharyngeal carcinoma, as it is an insidious malignancy which needs to be precisely identified.

scholarly journals Aortic Dissection in a Healthy Male Athlete: A Unique Case with Comprehensive Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Balraj Singh ◽  
Jennifer M. Treece ◽  
Ghulam Murtaza ◽  
Samit Bhatheja ◽  
Steven J. Lavine ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Anabolic Steroids ◽  
Venous Pressure ◽  
Ascending Aorta ◽  
Type I ◽  
Delay In Diagnosis ◽  
Long Time ◽  
Aortic Root Dilatation ◽  
History Of

A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air. Physical exam was significant for elevated jugular venous pressure, muffled heart sounds, and cold extremities with diminished pulses in upper and absent pulses in lower extremities. Bedside echocardiogram showed aortic root dilatation and cardiac tamponade. STAT computed tomography (CT) scan of chest revealed dissection of ascending aorta. Cardiothoracic surgery was consulted and patient underwent successful repair of ascending aorta. Hemodynamic stress of weightlifting can predispose to aortic dissection. Aortic dissection is a rare but often catastrophic condition if not diagnosed and managed acutely. Although rare, aortic dissection needs to be in the differential when a young weightlifter presents with chest pain as a delay in diagnosis may be fatal.

scholarly journals Aortic Dissection - The Role of Echocardiography in Emergency Unit: Case Report

2016 ◽  
Vol 33 (1) ◽  
pp. 69-74
Author(s):  
Sanja Stojanović ◽  
Marina Deljanin Ilić ◽  
Stevan Ilić ◽  
Bojan Ilić ◽  
Milovan Stojanović ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Past History ◽  
Emergency Unit ◽  
Lethal Outcome ◽  
Hemodynamic Compromise ◽  
History Of ◽  
Heart Auscultation ◽  
Very High

Summary Aortic dissection is a quite rare but serious condition, often associated with a very high mortality rate; it is manifested by sudden chest pain and acute hemodynamic compromise. In the presented review, a case of an ascending aortic dissection with the lethal outcome is been shown. A healthy man with no past history of illness suddenly felt acute excruciating chest pain which was radiating to the back. A quick diagnosis, ideally within one hour of manifestation, heart auscultation and echocardiography are the key to aortic dissection recovery.

scholarly journals Type a Aortic Dissection Presenting with Acute Lower Extremity Vascular Insufficiency in the Absence of Chest Pain

2012 ◽  
Vol 5 ◽  
pp. OJCS.S8042
Author(s):  
Thomas J. Earl ◽  
Athena Poppas
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Lower Extremity ◽  
Type A ◽  
Type A Aortic Dissection ◽  
Non Invasive ◽  
Left Lower Extremity ◽  
Vascular Insufficiency ◽  
History Of ◽  
Aortic Dissections

We report a case of a 53 year-old man with a history of hypertension presenting with acute left lower extremity parasthesias and pulselessness initially presumed to be secondary to arterial thrombosis or embolism. Work-up included a transthoracic echocardiogram which revealed an aortic dissection at the level of the aortic root extending to the visualized portions of the descending aorta. Type A aortic dissections are relatively rare, with the vast majority of patients presenting with chest pain. Timely diagnosis of Type A aortic dissections are critical as to facilitate rapid surgical repair. To our knowledge, this is the first report of a painless Type A aortic dissection presenting with isolated lower extremity vascular insufficiency and demonstrates the potential role of transthoracic echocardiography as a rapid, non-invasive bedside modality in visualizing Type A aortic dissections.

Case Report: Type 1 aortic dissection presenting as acute pericarditis: the roles of POCUS and transthoracic echocardiography

POCUS Journal ◽  
2017 ◽  
Vol 2 (3) ◽  
pp. 22-23
Author(s):  
Bill Ayach, MD, PhD ◽  
Aadil Dhansay, MD ◽  
Andrew Morris, MD ◽  
James W. Tam, MD ◽  
Davinder S. Jassal, MD
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Clinical Presentation ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Laboratory Findings ◽  
Acute Pericarditis ◽  
History Of

Clinical Presentation: A 59 year old male presented with a 1 day history of non-exertional chest pain that was pleuritic in nature and aggravated by lying flat. His chest pain symptoms were preceded by a one week history of “flu-like” symptoms. Physical exam demonstrated a blood pressure of 114/55 mmHg, heart rate of 75 bpm, and a normal oxygen saturation on room air. Cardiac examination revealed a biphasic pericardial rub vs. to-and-fro murmur. EKG demonstrated diffused ST-elevation and PR depression consistent with acute pericarditis. Laboratory findings revealed a normal WBC of 11.2×109/L and hsTnT of 78 ng/L. Imaging Findings: A point of care ultrasound (POCUS) assessment demonstrated mild aortic insufficiency with a dilated ascending aorta with no pericardial effusion or wall motion abnormalities. An expedited transthoracic echocardiography (TTE) confirmed a bicuspid aortic valve with moderate aortic insufficiency. The aortic root and ascending aorta were dilated at 50 and 52 mm, respectively. There was evidence of an aortic dissection flap prolapsing across the left ventricular outflow tract. A dissection flap was also visualized within the abdominal aorta consistent with a Type 1 aortic dissection. Computed tomography of the aorta confirmed the Type 1 aortic dissection and the patient underwent an urgent valve-sparing aortic root replacement procedure. Discussion Points: Despite a typical clinical presentation for acute pericarditis, any unexpected physical exam or laboratory findings should lead to a POCUS assessment. This case demonstrates a rare presentation of aortic dissection which could have been easily missed without a POCUS assessment. Here we propose an algorithm for a POCUS examination in setting of pleuritic chest pain consistent with pericarditis.

scholarly journals Clinical Analysis of NMOSD with Area Postrema Syndrome as Initial Symptom

2021 ◽  
Author(s):  
Ting Liu ◽  
Lijuan Li ◽  
BinJi Liang ◽  
Xian Li ◽  
Lin Ma
Keyword(s):  
Life Support ◽  
Area Postrema ◽  
Clinical Manifestations ◽  
Clinical Analysis ◽  
Nausea And Vomiting ◽  
Initial Symptom ◽  
Mri Findings ◽  
Initial Manifestation ◽  
Initial Symptoms ◽  
Significant Clinical Improvement

Abstract Objective: Patients with neuromyelitis optica spectrum disease (NMOSD) with the initial manifestation of area postrema syndrome (APS) often have unexplained nausea and vomiting and are easily misdiagnosed for the NMOSD. The purpose of this study was to report and discuss clinical analysis, including diagnosis and treatment of 4 cases of NMOSD with APS as the first symptom.Methods: Four patients with intractable nausea and vomiting were selected for the analysis and finally the cases were confirmed for the NMOSD. All of these patients started with misdiagnosis and mismanagement initially.Results: Among the 4 patients included in this study, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 of them were not correctly diagnosed and treated on time due to misdiagnosis. Therefore, their symptoms worsened, and they needed to be transferred to ICU for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange but there was no significant clinical improvement, and then the disease was relapsed during the treatment with low-dose rituximab.Conclusion: The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and MRI findings can all influence the clinicians' judgment of the disease. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease.

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