title: A case of painless acute Type-A thoracic aortic dissection.
abstract: We describe the case of an 83-year-old lady with a known aneurysmal thoracic aorta, developing acute breathlessness and hypoxia, with no pain and unremarkable cardiovascular examination. As D-dimers were raised, she was treated with low-molecular-weight heparin (LMWH) for suspected pulmonary embolism. CT pulmonary angiography showed acutely dissecting, Type-A, thoracic aortic aneurysm. The patient was treated medically with β-blockers. Despite a poor prognosis, she remains well 2 months later. Observational studies of patients over 70 with Type-A dissection show only 75.3% experience pain, are offered surgery less and have higher mortality. d-Dimers are almost always elevated in aortic dissection. No previous studies document breathlessness as the only presenting symptom. This case emphasises the need, in older populations, for a low suspicion threshold for aortic dissection.
authors.affiliation: Elderly Medicine, North Tyneside General Hospital, Rake Lane North Shields, Tyne and Wear NE29 8NH, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: Catlow
authors.affiliation: Elderly Medicine, North Tyneside General Hospital, Rake Lane North Shields, Tyne and Wear NE29 8NH, UK.
authors.forename: Tarquin
authors.initials: T
authors.lastname: Cross
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D017545:Aortic Aneurysm, Thoracic / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D001027:Aortography / Q000379:methods; D015415:Biomarkers / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D010166:Palliative Care; D011237:Predictive Value of Tests; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Type A aortic dissection; d-dimer; older people; painless