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A Deadly Tear to Fear An Interesting Case Presentation on Aortic Dissection

Marianne Ginellee G. Faustino, MD
Elmer M. Angus, MD*


Objectives: 1) To present a case of a patient with aortic dissection. 2) To show how the case arrived to its plausible diagnosis. 3) To discuss other illnesses discovered in the case.
Case Summary: This is a case of a 54-year old, female, Filipino, Catholic, who presented with severe chest pain, substernal in location, with pain intensity of 8/10 associated with diaphoresis and dyspnea leading to fainting spells. Initial impression was cardiogenic shock secondary to Non-ST elevated myocardial infarction. On physical examination, the patient was drowsy and in cardio-respiratory distress. She had symmetrical chest expansion and no retractions were noted. Clear breath sounds were noted in all lung fields. She had an adynamic precordium with normal rate and regular rhythm, however with distant heart sounds. There was no murmur, heave or thrill appreciated. Vital signs at the emergency room showed a blood pressure of 110/80 which eventually became 80/50 mmHg, respiratory rate of 22 cycles per minute, heart rate of 80-100 beats per minute and was afebrile. Patient was scheduled for a stat coronary angiography, however on further reassessment, repeat ECG showed resolution of the inferolateral wall ischemia but this could not explain her fluctuating blood pressure. When the patient underwent the scheduled bedside 2D echo, a moderate cardiac tamponade was discovered with a 4.5 cm aortic dissection. With these findings, patient underwent aortic repair, graft insertion with evacuation of hematoma. She was discharged stable and with no recurrence of chest pain.
Key Words: Aortic Dissection, Cardiac Tamponade, Transthoracic Echocardiogram (TTE), Transesophageal Echocardiogram (TEE)

*Adviser/Consultant,Departmentof FamilyandCommunityMedicine