Atypical presentation of acute type A aortic dissection as acute coronary syndrome highlights the critical role of bedside echocardiography in the evaluation of acute chest pain.
Acute type A aortic dissection (ATAAD) is a time-sensitive and life-threatening emergency that usually presents as sudden, severe pain radiating to the back. Atypical presentations such as acute coronary syndromes make it challenging to diagnose, hence delaying the management. We report a case of a 57-year-old male with a history of hypertension, diabetes, dyslipidemia, and chronic smoking who presented to the emergency department with central chest heaviness that radiated to the left hand associated with diaphoresis. Normal cardiac enzymes and an electrocardiogram (ECG) led to the initial diagnosis of unstable angina. As a result, he was given dual antiplatelets, which provided temporary relief of his symptoms. However, before discharge, a bedside transthoracic echocardiography found a retrograde ATAAD with the double aortic valve sign, a rare echocardiographic finding, along with severe aortic regurgitation. Further imaging with CT angiography confirmed the diagnosis despite the patient not complaining of any pain. Due to the involvement of the aortic root, valve, and right coronary artery, he underwent the Bentall procedure. Postoperative management emphasized initiation of anticoagulation, controlling the blood pressure, and management of cardiovascular risk factors to prevent aortic dissection and aneurysm. The patient recovered from the postoperative course without complications and remained stable upon follow-up. ATAAD should remain in the differential diagnosis for acute chest pain even in the absence of a typical presentation. Bedside echocardiography is a useful initial diagnostic tool, and early multidisciplinary management supports successful patient outcomes.
Elzoghby et al. (Mon,) studied this question.