Aortic Dissection Presenting with New Onset Atrial Fibrillation: A Very Unusual Presentation

摘要

Acute aortic dissection (AAD) is a cardiovascular emergency, and is usually fatal unless treated promptly. Presenting symptoms are generally chest or back pain, and elevated blood pressure (BP). Other common presentations are syncope, murmur of aortic regurgitation, and pulse deficit. Common electrocardiographic changes, if any, are due to cardiac ischemia. The presenting clinical features of AAD are diverse, and severe complications occur very rapidly.There are only two case reports in the literature describing an association of atrial fibrillation (AF) with AAD, but none has been reported in an ambulatory setting. We treated a 76-year-old man with known hypertension, well controlled on enalapril, who was seen in the clinic for palpitations that he had been experiencing that day. He also complained of vague pain over his left lower chest, upper abdomen, and mid upper back; it was a constant, dull ache with no aggravating or alleviating factors. He did not have a history of coronary artery disease. Coronary angiog-raphy had been performed two weeks prior for exertional chest pain, which ruled out any critical epicardial coronary artery lesion.