Atrial fibrillation and stroke as initial manifestations of painless type A aortic dissection

Stöllberger, Claudia; Schäffl-Doweik, Lilian; Korn, Maria; Finsterer, Josef

doi:10.1016/j.pjnns.2017.07.008

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…AD, which might involve coronary injury, pericardial involvement, and other direct cardiac effects, could increase the risk of AF. [3][4][5][6][7][8][9] However, there is no argument made in support of an association between AD and subsequent AF although several molecular mechanisms involving the atrial remodeling and weakness of the aortic walls might be possible explanations. [15][16][17][18] Such findings based on this big dataset deserved further investigation.…”

Section: Studymentioning

confidence: 99%

“…Aortic dissection (AD) is a life threating disease once left undiagnosed or untreated. 1,2 The phenomenon of AD presenting with atrial fibrillation (AF) has indeed been discussed previously [3][4][5][6][7][8][9] ; in case of subclinical AD, AF may occur and be a sign of alert. For clinicians who care for patients with AF, it is well known that stroke, heart failure, and death are common AF complications.…”

Section: Introductionmentioning

confidence: 99%

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Bidirectional association between aortic dissection and atrial fibrillation: Findings from a huge national database

Lin

2019

Clinical Cardiology

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Objective To explore the link between aortic dissection (AD) and atrial fibrillation (AF). Methods Using the National Health Insurance Research Database (NHIRD), cohorts were constructed for evaluating the incidence of AF in patients with AD (study 1) and the incident AD among AF patients (study 2) based on propensity matching analysis. Cox proportion hazard regression models were used to examine the effect of AD on the risk of AF, shown as hazard ratios (HRs) with 95% confidence intervals (CIs). Similar statistical procedures were used for study 2. Results The study 1 consisted of 11 813 patients in the AD cohort and 11 813 controls in the non‐AD cohort and the study 2 consisted of 190 494 patients in the AF cohort and 190 494 controls in the non‐AF cohort. The overall incidence density of AF was 1.32‐fold higher in the AD cohort than in the non‐AD cohort (11.1 and 8.3 per 1000 person‐years), with an adjusted HR (aHR) of 1.74 (95% CI = 1.53‐1.98). The AF cohort had 1.18‐fold higher incidence of AD than the non‐AF cohort (0.55 vs 0.47 per 1000 person‐years), with an aHR of 1.24 (95% CI = 1.07‐1.44). Conclusions Bidirectional association between AD and AF was shown for the first time in this study.

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Section: Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bidirectional association between aortic dissection and atrial fibrillation: Findings from a huge national database

Lin

2019

Clinical Cardiology

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“…More and more cases of non-painful or minimally painful AD are described in the literature [2][3][4]. Sometimes they present with atypical symptoms such as syncope, seizures, paraplegia, vertigo, atrial fibrillation, ileus [4][5][6]. These varied symptoms may reveal ischemic organ damage related to aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

Painless Stanford A Aortic Dissection: A Case Report

Gabin,

Julien,

Yamen

et al. 2023

Clin Med Rev Case Rep

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Background: Stanford A aortic dissection is a surgical emergency. Its misleading clinical presentations sometimes makes its diagnosis difficult. Case presentation:We describe the case of a 58-yearold black male smoker patient with untreated hypertension admitted to the emergency room without symptoms, having presented a few hours earlier, moderate chest pain with transient sweating. The clinical examination found blood pressure asymmetry and a weaker radial pulse on the right arm. The ECG showed nonspecific abnormalities. D dimers were greater than 20,000 µg/L. Chest CT angiography showed Stanford type A aortic dissection. The patient underwent emergency surgery with aortic valve replacement, placement of a supracoronary tube and repair of the aortic pellet with simple postoperative course. Conclusion:Although Stanford A aortic dissection is rare, clinician should be aware of it while facing a patient with transcient chest pain and cardiovascular risk factors, especially high blood pressure.

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Underappreciated Relationship: A Case of Type A Aortic Dissection Presented With Atrial Flutter

Al Rayess,

Ozgur,

Challita

et al. 2024

Journal of Investigative Medicine High Impact Case Reports

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Aortic dissection (AD) is a life-threatening emergency involving a tear in the aortic intima, leading to a false lumen. Atrial fibrillation (AF) can complicate AD, increasing management challenges and mortality risks. We report a 67-year-old male with no known past medical history who presented with a 1-day history of abdominal pain. Initial examination showed mild hypertension, elevated bilirubin level, and leukocytosis. Imaging studies indicated gallbladder distension with cholelithiasis. Discharged with outpatient follow-up for elective cholecystectomy, the patient returned 2 days later for preoperative clearance, was hypertensive and tachycardic, presented with atrial flutter, and was referred to the emergency department. A 2D echo showed left ventricular ejection fraction (LVEF) 35% to 40% and pericardial effusion. Transesophageal echocardiography (TEE) revealed LVEF 50% to 55% and no thrombus, converting to sinus rhythm postcardioversion. The TEE also suggested type A AD, confirmed by computed tomography (CT) angiography, showing dissection from the aortic valve to the left external iliac artery with pericardial effusion. Emergent surgical repair was performed, and the patient was stabilized and discharged with follow-up. This case illustrates the complexity of diagnosing and managing AD, especially with concurrent AF. Recognizing the association between AD and AF is essential as AF increases in-hospital mortality in AD patients.

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Atrial fibrillation and stroke as initial manifestations of painless type A aortic dissection

Cited by 4 publications

References 10 publications

Bidirectional association between aortic dissection and atrial fibrillation: Findings from a huge national database

Bidirectional association between aortic dissection and atrial fibrillation: Findings from a huge national database

Painless Stanford A Aortic Dissection: A Case Report

Underappreciated Relationship: A Case of Type A Aortic Dissection Presented With Atrial Flutter

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