Aortic dissection: Case report and review of the literature

Abstract

Introduction: aortic dissection is the outflow of blood through a tear in the intima of the aorta, with separation of the intima and media layers and the creation of a false lumen (channel). The tear in the intima may be a primary event or due to hemorrhage within the media layer. Dissection can occur in any portion of the aorta and extend proximally or distally to other arteries.
Case presentation: 49-year-old black male patient, 49 years of age, who came to the emergency room of the Abel Santa María Cuadrado Hospital because he reported waking up with oppressive, tearing pain in the center of the chest, radiating to the neck and interscapular region, lasting 20 to 30 minutes, accompanied by pallor, sweating, coldness, nausea and shortness of breath, for which he took two tablets of Dipyrone to relieve the pain without any effect. For this reason it was decided to admit him for further study and treatment.
Conclusions: it was decided to defer surgery for the time being and maintain periodic follow-up by angio CT which will allow assessing the behavior of the dimensions of the dissecting aneurysm, signs of rupture and invasion of neighboring structures. With pharmacological treatment of esmolol administered as an initial bolus of 1,000 μg/ kg and then in continuous perfusion of 150-300 μg/kg/min. Sodium nitroprusside in initial doses of 0.3 micrograms/kg per minutes is effective for severe arterial hypertension, with the aim of reducing the heart rate thus limiting the ejection force of the left ventricle, normalizing the systolic blood pressure to figures around 100-120 mmHg or the minimum degree necessary for adequate perfusion and a heart rate (HR) of 60 to 80 beats/min.