A case report of painless type A aortic dissection with intermittent convulsive syncope as initial presentation

Abstract

Rationale:The initial presenting symptoms and signs of acute aortic dissection are so diverse that it makes early and accurate diagnosis arduous. Painless and convulsive syncope due to cardiac arrhythmia were not typical presentations of acute aortic dissection.Patient concerns:A 61-year-old male presenting with transient consciousness loss and suspected seizure attack was sent to emergency room (ER) by ambulance. Consciousness loss accompanying with upward gaze and limb convulsion was noted in ER, and electrocardiogram monitor recorded a transient cardiac asystole then spontaneous recovery of sinus rhythm.Diagnoses:Chest X-ray revealed widening of the mediastinum. Subsequently, contrast-enhanced chest computed tomography demonstrated Stanford type A aortic dissection.Lessons:To the authors’ knowledge, this is the first reported case that cardiac asystole may be related to painless type A aortic dissection and then leading to convulsive syncope as presenting symptoms.

Incidental Finding of an Asymptomatic Aortic Dissection in a Patient With Catheterization Failure

“…Patients with painless AD can present with other symptoms such as syncope [9], vomiting, amnesia [10], paraplegia [11], and stroke. Dissection of the intima obstructs blood flow to multiple organs leading to the above-mentioned symptoms and tearing causes pain.…”

Stanford Type a Aortic Dissection Presenting with Dyspnea: A Case Report

“…Type A is seen more with painless presentation [ 5 ], with syncope, congestive heart failure (CHF), and stroke being more frequent presenting symptoms in this group [ 6 ]. Most of the aortic dissection with painless presentation has normal electrocardiogram (ECG) [ 7 ], but different types of arrhythmias such as atrioventricular block, atrial fibrillation, supraventricular tachycardia, ventricular bigeminy and even complete heart block has been reported [ 2 ].…”

“…Acute aortic dissection is relatively uncommon condition and could represent a challenge due to its varying initial clinical presentations with symptoms and signs that overlap with other entities, while at the same time it is crucial to make a prompt diagnose and management [ 2 ]. Abrupt onset chest pain is the most common presenting symptoms and mostly describes as sharp, tearing, ripping and excruciating with the maximum severity at the time of onset [ 1 ].…”

Asymptomatic long‐segmental type A aortic dissection diagnosed by transthoracic echocardiography: A case report and literature review

“…17 Painless AD is uncommon, with a reported incidence of 5% to 15%. 18,19 However, painless AD can manifest with a wide variety of other symptoms, including syncope, 20 paraplegia, 21 amnesia, 22 dyspnea, 23 nausea, vomiting, 24 dysphagia, hoarseness, 25 and vertigo. 26 These other symptoms may result from the dissected intima obstructing the blood supply to the target organs.…”