Acute aortic dissection (AAD) is a cardiovascular emergency that requires emergent surgical, endovascular, or medical intervention depending on the portion of the aorta implicated, as dictated by the Stanford classification, and the extent of aortic involvement. Acute chest pain radiating to the back is typically seen in AAD and may be associated with radial pulse deficits. A high index of suspicion is required to diagnose and initiate management of this emergency as early as possible. This is a report of an atypical presentation of an extensive aortic dissection identified in a young man without most of the typical risk factors, but which was promptly diagnosed and treated.

Background: How the incidence of infective endocarditis (IE) changed in various age, sex and racial/ethnic subgroups of the United States along with the worsening opioid epidemic over the last decade is unknown. Methods: We utilized data from the 2005-2018 State Inpatient Databases (SID)) of two large demographically diverse states (Florida and New York) to conduct a retrospective cohort study. Cases of incident IE identified using validated International Classification of Diseases codes were combined with census data to compute age, sex- and race-specific incidence. Joinpoint regression was used to quantify the annualized percentage change (APC) in incidence over time. Results: Of 98,221 incident IE admissions, 70.0% were Non-Hispanic White (NHW) and 60.6% were ? 65 years old (yo). The average annual age and sex-standardized incidence of IE in cases/100,000 population was 19.2 (95%CI 18.7-19.6) but this varied by age, sex and race. Incidence was ?20% higher in men (20.9 [95%CI 20.2-21.7]) compared to women (17.5 [95%CI 16.8-18.2]) and increased with age in both sexes. Incidence was higher in Non-Hispanic Blacks (NHB); 22.5(95%CI 21.0-23.9) compared to NHW: 20.0(95%CI 19.3 to 20.6), Hispanic: 13.2(95%CI 12.3-14.1) and Asian/Pacific Islander patients: 5.9(95%CI 4.7 to 7.1). The age and sex-standardized incidence did not change over time (APC 0.5%, p=0.646). However, incidence increased in women 18-44 (APC 11.0%, p<0.001), men 18-44 (APC 7.3, p<0.001) and 45-64 yo (APC 1.5%, p=0.002) but declined in women ? 65 yo (APC -2.8, p=0.049). Most of this increased incidence occurred in NHW women 18-44 (APC 16.6%, p<0.001), NHW men 18-44 (APC 10.6%, p<0.001), NHW men 45-64 (APC 2.8%, p<0.001) and Hispanic Men 18-44 yo (APC 5.6%, p<0.001). Incidence did not change over time in these age/sex groups of NHB and in other age/sex groups. Prevalence of opioid use disorder increased by >2-fold in all age/sex groups over time but the pace of increase was faster in NHW women and men 18-44 yo compared to other races of similar demography (p-for-time interaction <0.001). Conclusion: Over the last two decades, among residents of Florida and New York, incidence of IE increased in several demographic groups, but the most prominent rise was among young NHWs, particularly young NHW women.