title: [A case of acute and intense thoracic pain during a dental treatment].
abstract: METHODS
  We report on a patient with known hypertension, who presented to his general practitioner with severe thoracic pain of sudden onset. The aches had started during a dental treatment. Immediately, the patient was admitted to hospital by the general practitioner because myocardial ischemia was suspected.
  
  
  METHODS
  Neither the electrocardiogram nor the laboratory findings (creatin kinase, troponin I) argued for an acute coronary syndrome. Since the plasma D-dimer level was increased and the transthoracic echocardiography showed discrete signs of right ventricular strain, pulmonary embolism could not be ruled out. Because of the high intensity of pain and for further diagnostics the patient underwent a contrast medium-enhanced computed tomography (CT).
  
  
  METHODS
  The contrast medium-enhanced CT showed a type B acute aortic dissection. According to the current guidelines for the treatment of type B aortic dissection, a conservative therapeutic regimen was applied. Antihypertensive therapy was escalated. Furthermore, the patient transiently received analgesic drugs. After three weeks the patient was released from hospital without pain and with physiologic blood pressure under intensified antihypertensive therapy. A follow up examination three months after the acute aortic dissection showed a constant aortic diameter. Therefore, surgical treatment was not indicated.
  
  
  CONCLUSIONS
  This case report illustrates a typical clinical picture of acute aortic dissection and gives an overview about its epidemiology, classification, pathogenesis, and prognosis. Furthermore, the diagnostic opportunities and the current guidelines for the treatment of acute aortic dissection are discussed.
authors.affiliation: Medizinische Universitätsklinik Tübingen, Abteilung für Endokrinologie, Diabetologie, Nephrologie, Angiologie und Klinische Chemie. guenther.silbernagel@med.uni-tuebingen.de
authors.forename: Günther
authors.initials: G
authors.lastname: Silbernagel
authors.forename: Klaus
authors.initials: K
authors.lastname: Brechtel
authors.forename: Jan
authors.initials: J
authors.lastname: Stock
authors.forename: Elko
authors.initials: E
authors.lastname: Randrianarisoa
authors.forename: Wilke
authors.initials: W
authors.lastname: Schneider
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ziemer
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Häring
authors.forename: Bernd
authors.initials: B
authors.lastname: Balletshofer
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis*; D000208:Acute Disease; D000784:Aortic Dissection / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017545:Aortic Aneurysm, Thoracic / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D002637:Chest Pain / Q000097:blood / Q000209:etiology*; D003402:Creatine Kinase / Q000097:blood; D003729:Dental Care; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D004630:Emergencies; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D019210:Troponin I / Q000097:blood
chemical_list: D000959:Antihypertensive Agents; D005338:Fibrin Fibrinogen Degradation Products; D019210:Troponin I; C036309:fibrin fragment D; D003402:Creatine Kinase