Fatal and Near Fatal Acute Ascending Aortic Dissection: Two Case Reports with Different Cardiac Manifestations

Main Article Content

Gumpanart Veerakul, MD
Manaswee Indrabhinduwat, MD
Pakaporn Sirimas, MD
Lertlak Chaothawee, MD
Sucharat Warutama, MD
Vitoon Pitiguagool
Piyapan Pamornsing, MD


Acute ascending aortic dissection (AD) is a rare disease and carries a high fatality rate. Its mortality increased with time, 1-2% every hour after symptom onset. Occasionally,  the diagnosis of acute AD could be missed or delayed since its  presentation can mimic any arterial occlusive diseases including  acute coronary syndrome, limb ischemia and stroke. To raise  awareness of the medical community, we report on two acute  ascending AD patients who presented with different cardiac  manifestations.

Article Details

How to Cite
Veerakul G, Indrabhinduwat M, Sirimas P, Chaothawee L, Warutama S, Pitiguagool V, Pamornsing P. Fatal and Near Fatal Acute Ascending Aortic Dissection: Two Case Reports with Different Cardiac Manifestations. BKK Med J [Internet]. 2014 Sep. 20 [cited 2024 Feb. 21];8(1):59. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/220010
Case Report


1. Tsai TT, Nienaber CA, Eagle KA. Acute Aortic Syndromes. Circulation 2005:112:3802-13.
2. Meszaros I, Morocz J, Szlavi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest 2000;117: 1271-8.
3. Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population-based study. Surgery 1982;92:1103-8.
4. Clouse WD, Hallette JW Jr, Schaff HV, et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc 2004;79:176-80.
5. DeSanctis RW, Doroghazi RM, Austin WG, et al. Aortic dissection. New Engl J Med 1987; 317:1060-7.
6. Erbel R, Alfonso F, Boileau C et al. Diagnosis and management of aortic dissection. Eur Heart J 2001;22:164281.
7. Hagan PG, Nienaber CA, Isselbacher EM et al. The inter-national registry of acute aortic dissection (IRAD): New insight into an old disease. JAMA 2000; 283:897-903.
8. Evangelista A, Mukherjee D, Mehta RH et al. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation 2005; 111:1063-70.
9. Veerakul G, Grudpoo P, Niyomthai A, et al. Fatal penetrating aortic ulcer and aorto-iliac occlusion mimics acute coronary syndrome: A case report and literature review. Bangkok Med J 2014;7:43-9.
10. Nienaber CA, Haverich A, Erbel R. Diseases of the aorta and trauma to the aorta and the heart in Camm AJ, Luscher TF, Serruys PW ed in The ESC Textbook of Cardiovascular Medicine, Blackwell Publishing 2006:993 1031.
11. Grupper M, Eran A, Shifin A. Ischemic stroke, aortic dissection and thrombolytic therapy−the importance of basic clinical skills. J Gen Intern Med 2007; 22:1370-2.
12. Lentini S, Perrotta S. Aortic dissection and concomitant acute myocardial infarction: From diagnosis to manage- ment. J Emerg Trauma Shock 2011;4:273-8.
13. Patane S, Marte F, Lentini S, et al. Obstruction of the right coronary artery ostium due to acute aortic dissection. Int J Cardio 2009;133:135-7.
14. English P, Kishore M. Aortic dissection and rupture presenting as suprastenal bruising and neck swelling. Age Ageing 2002;31:310-2.
15. Nallamothu BK, Mehta RH, Saint S, et al. Syncope in acute aortic dissection: diagnosis, prognosis, and clinical implications. Am J Med 2002;113:468-71.
16. Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type A aortic dissection. Circulation 2002;105:200-6.
17. Hiratzka LF1, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery,American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Catheter Cardiovasc Interv 2010;76:E43-86.
18. Isselbacher EM, Cigarroa JE, Eagle KA. Cardiac tam-ponade complicating proximal aortic dissection: is pericardiocentesis harmful? Circulation 1994;90:2375-8.