Suspected Acute Stanford Type A Aortic Dissection: A Case Report

Abstract

Background: Acute Stanford type A aortic dissection carries 1– 2% hourly mortality if medically managed. Misdiagnosis as hypertensive emergency delays surgery. In African settings without immediate computed tomography angiography (CTA) access, bedside echocardiography guides triage. Case Presentation: A 58-year-old man with uncontrolled hypertension presented to the emergency department of the Federal Teaching Hospital, Owerri, Nigeria, with sudden tearing chest and back pain, diaphoresis, and dyspnea. Blood pressure was asymmetric at 210/115 mmHg in the right arm versus 180/100 mmHg in the left arm, with a new grade 2/6 early diastolic murmur of aortic regurgitation. Electrocardiography showed nonspecific ST-T changes. Chest radiography revealed cardiomegaly (cardiothoracic ratio 0.65) and mediastinal widening exceeding 8 cm. Serial troponin I remained negative at presentation and at 3 hours. Transthoracic echocardiography demonstrated aortic root dilatation to 5.4 cm, ascending aorta dilatation to 6.3 cm with intimal flap visualization, severe aortic regurgitation (vena contracta 0.70 cm), and mild pericardial effusion findings highly suggestive of suspected Stanford type A aortic dissection. Intravenous labetalol reduced heart rate to 55– 60 beats per minute, followed by nicardipine titrated to systolic blood pressure 120– 130 mmHg, stabilizing the patient for surgical referral. Conclusion: Blood pressure asymmetry, aortic regurgitation murmur, chest radiographic widening, and echocardiographic intimal flap enable recognition of suspected type A aortic dissection without CTA, preventing misclassification as hypertensive emergency. Keywords: aortic dissection, hypertensive emergency, echocardiography, asymmetric blood pressure, Africa