SUBMISSION TYPE: Case Presentation
TITLE : Painless aortic dissection presenting as aortic insufficiency
AUTHORS : Carl Kim 1 , Yuang Wen 2 , Emily G. Knafl 2 , Priscilla Becnel 1, 2
INSTITUTIONS: 1. Ochsner Clinical School- The University of Queensland, New Orleans, LA, United States. 2. Department of Internal Medicine, Ochsner Health System, New Orleans, LA, United States. ABSTRACT BODY: Introduction: Painless aortic dissection (AoD) comprises of about 6% of all reported aortic dissection cases. We present a case of a painless aortic dissection presenting as aortic insufficiency. Case Presentation: A 39-year-old Caucasian male presented with progressively worsening shortness of breath, orthopnea and lower extremity edema. Patient denied chest or back pain. The patient had a heart rate of 101 beats per minute, but otherwise normal vital signs. On examination, he had an elevated jugular venous pressure, non-pitting peripheral edema, and a grade II diastolic decrescendo murmur loudest at the left upper sternal border. Distal pulses were present and equal. Laboratory workup was significant for brain natriuretic peptide 1574pg/mL. Chest radiograph noted bilateral basilar lung opacities without mediastinal or aortic silhouette widening. Transthoracic echocardiogram noted ejection fraction of 30%, severe left atrial enlargement, moderate aortic regurgitation, and dilated ascending aorta of 5.29cm. View of the aortic arch and descending aorta showed a possible intimal flap. Follow-up computed tomography angiogram revealed an aortic dissection originating at the aortic root and extending to the level of the left common iliac artery. Patient was transferred to the Cardiac Care Unit and taken for aortic repair the following day.
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