Painless aortic dissection: thrombolytic and antithrombotic vigilance

We thank Huang et al for their interesting article on identification of painless aortic dissection (AD) before thrombolytic treatment for acute ischemic stroke. We would like to emphasize the importance of being vigilant to AD before initiating any contraindicated therapy. We recently had an 84-year-old man with history of atrial fibrillation and transient ischemic attack who presented to the emergency department with acute shortness of breath without chest pain. The symptom contributed to atrial fibrillation with rapid ventricular response. Chest x-ray showed increased soft tissue prominence of the aortic arch suspicious for AD or aneurysm. Subsequent computed tomographic angiography of the chest revealed Stanford type A ascending AD with contrast entering the false lumen and dilation of the proximal aorta. Esmolol intravenous bolus and continuous infusion were initiated. Hemiarch and ascending aorta replacement with Hema Shield graft was emergently done. Postoperative hospital course was uneventful. Patient was discharged home with warfarin therapy.
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Tags: Correspondence Source Type: research