Aortic Dissection

TuTorialangiography (CTA) confirmed a dissection at the ascending aorta, arch, and entire descending aorta inferiorly extending to involve both common iliac arteries and proximally to involve origins of all three aortic branches-type A dissection (Fig. 1).The patient was managed in the intensive care unit with intravenous antihypertensive agents aimed at maintaining systolic blood pressure below 120 mm Hg and strict heart rate control.Cardiothoracic surgical consultation was obtained, and plans were made for emergency ascending aorta replacement using a Dacron graft along with aortic valve repair.Early recognition, medical stabilization, and prompt surgical intervention remain pivotal to improving patient outcomes. CaseA 72-year-old woman with a medical history significant for hypertension and hyperlipidemia presented to the emergency department with sudden-onset severe tearing chest pain radiating to the back and between the shoulder blades.The pain was described as constant and unrelieved by rest or analgesics.She also reported associated diaphoresis and a brief episode of lightheadedness but denied syncope, palpitations, or shortness of breath.There was no prior history of trauma, connective tissue disorders, or known cardiovascular disease.On examination, the patient appeared distressed and diaphoretic.Her blood pressure was 180/95 mm Hg in the right arm and 150/90 mm Hg in the left arm, with a pulse rate of 98 beats per minute.Peripheral pulses were diminished on the left side.Cardiovascular examination revealed an early diastolic murmur best heard along the left sternal border.Respiratory and abdominal examinations were unremarkable.Initial investigations, including electrocardiogram and cardiac enzyme levels, showed no evidence of myocardial ischemia.However, given the acute presentation, unequal blood pressures, and characteristic pain, acute aortic dissection was strongly suspected.Urgent computed tomography (CT) aortography was planned for definitive diagnosis, and the patient was admitted to the medical intensive care unit for hemodynamic monitoring and blood pressure control.Bedside two-dimensional echocardiography demonstrated the presence of an intimal flap suggestive of aortic dissection.Subsequent computed tomography