When sprinting on last 100 m matters

Introduction: Aortic dissection is a disease of older age, with a mean onset at 55 years. Younger patients represented only 3,5 %, and the most common etiologies are connective disorders, aortic bicuspid, or coarctation of the aorta, vasculitis disorders, infections like lues, traumas. In a patient without genetic or autoimmune conditions, the most important risk factor for aortic dissection is arterial hypertension. The prevention of patients in this situation is very important, including searching for essential or secondary hypertension.

Methods: We present the case of a 35 years old male, nonsmoker, sedentary, who presents to the emergency room for severe dyspnea, moderate precordial pain and diaphoresis, symptoms started 6 hours before presentation. He has been known with severe and uncontrolled essential arterial hypertension. At clinical exam presents altered general condition, very anxious, extreme diaphoresis, cold extremities, RR= 30, rales on ½ of posterior thoracic, BP= 90/60 mmHg, HR= 90 bpm, diastolic murmur on the left parasternal auscultation area, Blood tests revealed minimal leukocytosis, DDi-mer test positive, ECG at the presentation shows sinus rhythm, HR= 90 bpm. Echocardiography revealed normal cardiac cavities, with normal ejection fraction and important aortic regurgitation, dissection fold propa-gating through the aortic valve into the LV, dilated as-cending aorta. We performed an abdominal fast echography which shows liver-renal multiple cysts. Abdo-minal CT revealed enlarged kidneys with disorganized architecture and multiple cysts suggestive for ADPKD. The patient was sent urgently to a cardiac surgery cen-ter, with an altered general condition. The patient is referred to a cardiac surgery center, with the diagnosis of acute dissection of aorta Stanford A, type I De Bakey; The patient was emergently operated. The ADPKD is confirmed. Angio RM is also indicated considering the increased association between cerebral aneurysms and polycystic disease. The patient was advised for genetic counseling.

Conclusions: ADPKD is an important condition and requires important preventive care including kidney disease, but also other organs implicated in the pro-gression of the disease like blood pressure monitoring, cysts in other organs, intracranial aneurysms, and also the risk of parental transmission. Arriving at a prompt diagnosis is critical for a favorable outcome. Despite unusual risk factors and atypical presentations, clinical suspicion remains the most important factor in recog-nizing aortic dissection in a young patient and ca be a life-savers.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)