The Golden Hour: A Case on Aortic Dissection

Authors: Meha Munir, Teresa Voong, Victoria DeTrolio

Emergency Medicine Student Interest Group, American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten


Acute aortic dissection syndrome (AADs) tends to be uncommon, however AADs are associated with a high mortality rate for patients if left untreated. Most patients will present with tearing chest pain that radiates to the back very similar to Acute Myocardial Infarction (MI) presentation. Despite the abundance of literature on AADs, a notable number of aortic dissections are missed in the emergency department. For every one-thousand patients presenting with acute back, chest or abdominal pain three patients with AADs are diagnosed in time for intervention. Therefore, physicians should be able to recognize patients with AADs versus the differential diagnosis of a much more common condition like MI. A swift diagnosis could ultimately save the patient and improve the quality of life and prognosis. 

The patient in the case provided presented to the ED with chest pain radiating straight through to the back which started two hours prior to presentation. The patient described the severity of pain as an 8 out of 10, and characterized the pain as a constant sharp, stabbing ache, and noted that nothing alleviated or aggravated the pain. After pharmacological intervention, the patient continued to have low blood pressure however radiographic results did not confirm evidence of a suspected AAA or MI. The patient suddenly developed atrial fibrillation and after four hours began to have respiratory failure. CPR was performed for 30 minutes, but unfortunately the patient succumbed to the illness. This is a fitting depiction of how a chief complaint of chest pain alluding to AAD can ultimately lead to death. When left untreated, about 33% of patients die within 24 hours, and there is a 50% mortality rate within 48 hours. The tremendously high mortality rate associated with AADs needs to be a subject of discussion for researchers, physicians, hospitals administration. The healthcare field needs to share responsibility and come to a conclusion regarding literature for quick diagnosis, reliable interventions, and best practices for cases of acute aortic dissection syndrome to ensure positive outcomes.

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