Question

A 65-year-old patient presented with chest pain with ECG changes. However, his transthoracic ECHO was normal and coronary arteries were normal on coronary angiography done through right radial artery. There was suspicion of aortic dissection while carrying out coronary angiography.
What is the likely diagnosis?

Hint:

In patients with chest pain and suspected aortic dissection, it is critical to consider the risk factors (e.g., hypertension, connective tissue disorders) and confirm the diagnosis with imaging like CT angiography or MRI.

Answer 1

Step 1: Understanding the clinical picture.
The patient presents with chest pain and ECG changes, which are commonly associated with conditions like acute coronary syndrome (ACS). However, the transthoracic echocardiogram (ECHO) and coronary angiography were normal, ruling out a myocardial infarction or significant coronary artery disease. The suspicion of aortic dissection arises, given the location of the chest pain and the potential for involvement of the aorta.

Step 2: Likely diagnosis.
Aortic dissection is the most likely diagnosis. This condition occurs when there is a tear in the inner layer of the aorta, allowing blood to flow between the layers of the aortic wall, which can lead to aortic rupture or compromise of blood flow to vital organs. The patient's chest pain, often described as tearing or sharp, and ECG changes are suggestive of this condition.

Step 3: Conclusion.
Given the clinical presentation and suspicion of aortic dissection, this is the most likely diagnosis. Further imaging is required for confirmation.