Case 1/2014 – Syncope Due to Cardiogenic Shock in a 25-year-old Male Patient

Clinical aspects

This is a case of a male patient, 25 years of age with no previously described clinical history that sought medical attention complaining of malaise and feeling faint. The clinical picture had started 1 hour before he sought the local hospital emergency room. The patient clinical evolution was dramatic, presenting at the examination as shock, initially of undetermined etiology, going to aortic dissection and cardiac tamponade, and culminating in death within hours of symptom onset, before any surgical intervention. Acute dissection of the ascending aorta was then identified, with rapid and catastrophic clinical deterioration, a determining factor for the diagnosis to be attained as early as possible, as well as an early and accurate intervention.

Acute aortic dissection is a cardiovascular emergency with high mortality, ranging from 50 to 68% in 48 hours, 70% at 1 week and 85% in 1 month. The intimal tear is transversal, located in 70% of cases in the aorta ascending (just above the aortic valve), 20% in the descending aorta after the aortic arch, and 10% in the transverse aorta. Once started, the dissection progression can be distal, retrograde or occur in both directions and be of varying extension ^, . In the present case, the aortic dissection started in the ascending portion, retrograde, with bending of the anterior plan between the true and false lumen, generating a mechanical obstruction to the left ventricular outflow tract ().

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