Stanford type A aortic dissection and sudden death due to ventricular fibrillation. Case report
Keywords:
Aortic disecction; Acute aortic syndrome; Sudden cardiac death; Ventricular fibrillation.; acute aortic syndrome; aortic dissection; case reports; sudden cardiac death; ventricular fibrillationAbstract
Introduction: aortic dissection is a serious condition characterized by the formation of a false lumen due to the rupture of the aortic intima. Its annual incidence ranges between 2.7 and 7.2x 100,000 inhabitats; its mortality rate is 0.7 to 3.2. Sudden death associated with ventricular fibrillation occurs in 22 % of patients, usually due to coronary, renal, or electrolyte compromise.
Objective: to describe an unusual case of aortic dissection and sudden death due to ventricular fibrillation.
Case presentation: a 55-year-old caucasian male patient with hypertension was admitted to the hypertensive emergency department with sudden, severe retrosternal pain, syncope, and exertional dyspnea. Angiotomography diagnosed Stanford type A aortic dissection extending to the right common iliac artery. During surgery, he suffered ventricular fibrillation, which was reversed with the first shock. In postoperative intensive care, ventricular fibrillation recurred, and after the second shock, he presented asystole. After 30 minutes of resuscitation maneuvers and administration of intravenous epinephrine, the patient did not recover and died.
Conclusions: the progression of aortic dissection is rapid and torpid; therefore, it is an emergency. Of the essential imaging techniques for diagnosis, angiographic computed tomography is the gold standard. Treatment is usually open surgery, with or without aortic valve replacement. This case provided unique diagnostic and imaging evidence regarding aortic dissection and renal or electrolyte compromise as causes of ventricular fibrillation. The latter is a rare but fatal complication.
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