Two cases of acute aortic dissection in Douala General Hospital within one month Nkemtendong Tolefac et al Acute Aortic Dissection at the Douala General Hospital: A Report of Two Cases (original) (raw)
Acute aortic dissection is the most frequent and lethal presentation of acute aortic syndromes with an incidence of 3-4 cases per 100.000 per year. In general, 20% of patients with aortic dissection die before reaching the hospital and 30% die during hospital admissions. We present two cases of acute aortic dissection we received in sequence over a period of one month: A case of Standford type A aortic dissection with extension to renal and iliac arteries initially misdiagnosed as acute myocardial infarction and a case of standford type B aortic dissection. A clinician may not attend to a case of aortic dissection in all his practice. High index of suspicion and initiation of appropriate registries are potential avenues to curb mortality. RÉSUMÉ La dissection aortique aiguë est la présentation la plus fréquente et la plus mortelle des syndromes aortiques aigus avec une incidence de 3-4 cas par 100.000 par an. En général, 20% des patients atteints de dissection aortique meurent avant d'atteindre l'hôpital et 30% meurent au cours des hospitalisations. Nous présentons deux cas de dissection aortique aiguë que nous avons reçus en séquence pendant un mois : un cas de dissection aortique de type A de Standford avec extension aux artères rénales et iliaques initialement mal diagnostiquée comme un infarctus aigu du myocarde et un cas de dissection aortique de type B. Un clinicien ne peut pas assister à un cas de dissection aortique dans toute sa pratique. Un indice élevé de suspicion et l'instauration de registres appropriés sont des moyens potentiels de limiter la mortalité. INTRODUCTION Acute aortic dissection (AD) is a critical diseases and the most frequent and lethal presentation of acute aortic syndromes. The incidence is about 3-4 cases per 100.000 per year(1). In its natural history without treatment, acute type A aortic dissection has a mortality rate of about 1% per hour initially, 50% by the 3rd day, and almost 80% by the end of the 2nd week. Death rates are lower but still significant in acute type B aortic dissection: 10% minimum at 30 days, and 70% or more in the highest-risk groups (2). In the literature, 20% of patients with AD die before reaching the hospital and 30% die during hospital admissions (3). Common predisposing factors to AD noted in the International Registry of Aortic Dissection (IRAD) were hypertension in 72% of cases, followed by atherosclerosis in 31% and previous cardiac surgery in 18% (4). The typical presentation of AAD is that of a man in his 5 th or 6 th decade of life presenting with retrosternal chest pains radiating to the back and on physical examination the blood pressure is asymmetrical in both arms (2). Diagnostic imaging studies in settings of AD are aimed to rapidly confirm or exclude the diagnosis, classify the dissection as proximal (Standford A or Debakey I and II) or distal lesions (Standford B or Debakey III) (5). The most commonly used imaging tool in the diagnosis of AD is thoracic CT angiogram (CTA). sensitivity of CTA is superior to 95% and specificity to 87-100%. Other imaging modalities include echocardiography and MRI (5). The management of AD depends on the type and the classification. AD type A is a surgical emergency whereas AD type B is managed medically except for specific surgical indications. Essentially, the initial objectives are normalization of blood pressure and lowering of left ejection fraction with objective of systolic blood pressure 100-120 mm Hg and heart rate < 60 beats/minute (6).
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