Painless Aortic Dissection in a Patient with Atrial Fibrillation: A Case Report

Thoracic aortic dissection is a potentially life-threatening condition with an associated high mortality rate if unrecognized. Historically, medical training and clinical practice have emphasized having a high index of clinical suspicion for thoracic aortic dissection when patients present with ripping or tearing chest or back pain that may be coupled with unequal pulses or blood pressures in the upper extremities. The sensitivity for this presentation approaches 90% and is possibly improved by the addition of a new neurologic deficit or widened mediastinum on chest x-ray [1]. Painless aortic dissections, however, present a particularly challenging subset of aortic dissections because they do not present with these classic symptoms. Yet, they are just as deadly and comprise a notable portion of all aortic dissection cases. We present a case involving painless aortic dissection identified serendipitously while evaluating a patient presenting with atrial fibrillation and dyspnea.