Primary Ventricular Fibrillation as The First Presentation of Aortic Dissection: A Case Report

Abstract

This study is about an infrequent first presentation of Aortic Dissection (AD), and it is primary Ventricular Fibrillation (VF). We present a 64-year-old woman with a history of hypertension who came with sudden retrosternal chest pain, dizziness, nausea, and vomiting. The patient suffered a cardiac arrest a few seconds after admission. Cardiopulmonary resuscitation (CPR) was done for her. An electrocardiogram (ECG) showed ST elevation that demonstrated acute anterior MI (Myocardial Infarction). Trans-thoracic echocardiography (echo) CT angiography demonstrated decreased left ventricular ejection fraction with normal LV size (LVEF=25%) and type A Stanford and type I DeBakey aortic dissection flap from root up to distal of abdominal Aorta. This is while the patient's first presentation was VF, and she had anterior MI, which is unusual for aortic dissection. Therefore, we must consider AD in patients with VF. We have to consider AD in anterior MI patients because of the contraindication of medication.

A Rare Initial Presentation of Aortic Intramural Hematoma: A Case Report and Literature Review

“…Timely imaging is vital for diagnosis, especially in hemodynamically unstable patients [ 10 ]. CTA is the gold standard for diagnosing aortic syndromes, however, MRI and echocardiography also have utility [ 11 ].…”

“…Patients must be followed serially with imaging due to the unpredictable nature of AIH. In some cases, the hematoma can propagate within the false lumen of the aortic wall and interfere with the heart’s physiologic properties, as described in Gheshlaghi et al’s report [ 10 ]. Recent reviews have also found worsening outcomes to be associated with radiologic findings of proximal migration of the hematoma, hematoma thickness >11 mm, aortic diameter >50 mm, progressive aortic enlargement, ulcer-like projections, focal intimal disruption, and poor blood pressure control [ 1 , 13 ].…”