Spontaneous aortic dissection in young normotensive pregnant lady is rare and life threatening to both mother and fetus. Aortic dissection commonly associated with connective tissue disorder (Marfan Syndrome, Ehler Danlos Syndrome), cardiac valve anomalies, previous cardiac surgery and trauma. We present a case of fatal Type A aortic dissection in a primigravida lady non hypertensive without risk factors.
Case Report :
A 24 year old primigravida presented to ED at 16 week of pregnancy for acute back pain with pain score of 10/10. No history of syncopal attack, chest pain, breathlessness or trauma. Vitals recorded BP 107 -122 / 60-90 , HR 75-83/minute, Temperature 37 degree and RR of 20/minute. Airway, breathing and circulation were normal. No radial radial or radial femoral delay. Pain localized at upper thoracic vertebra level. Bedside echo shows no pericardial effusion. Pain reduced to 2/10 with intravenous painkiller and discharged home. Patient remains asymptomatic throughout pregnancy (subsequent ANC uneventful) until at 38 weeks she suddenly complained of severe upper back pain and collapsed at home. She was then declared dead and post mortem finding was ruptured aortic dissection from arch or aorta extend to the inferior mesenteric artery branch.
Discussion and Conclusion :
Aortic dissection should be suspected in acute upper back pain and warrant for further investigation. This rare case is presented to raise awareness of possibility of aortic dissection in young pregnant lady with no risk factors and emphasizes the importance of maintaining a broad differential diagnosis and utilizing the necessary clinical tools to further direct patient care and necessary interventions. Pregnancy itself significantly increase the risk of vascular events. The increase force on aortic wall may exacerbated by increase outflow resistance in distal aorta caused by gravid uterus. This may explained why this patient collapsed at later stage of pregnancy.
AORTIC DISSECTION IN PREGNANCY
2.Lisa Kinney-Ham, H. Bryant Nguyen, Robert Steele, Elizabeth L Walters,Acute Aortic Dissection in Third Trimester Pregnancy without Risk Factors West J Emerg Med. 2011 Nov; 12(4): 571–574.
3.von Kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Arch Intern Med. 2000 Oct 23;160(19):2977-82.