Robert Skalik
Medical University of Wroclaw, Poland
Title: Acute aortic dissection - Relevance of hemostatic parameters for diagnostic process
Biography
Biography: Robert Skalik
Abstract
A 66-year-old woman was admitted to the emergency department after syncopal episode preceded by a crushing chest pain and bradycardia. On admission the patient presented with slight confusion and chest pain , varicose veins of the left lower extremity without swelling or signs of acute inflammatory process. The blood tests results showed thrombocytopenia, significantly elevated D-dimers level, lowered fibrinogen level and negative troponin test. Electrocardiography revealed signs of acute myocardial ischemia. On echocardiography, the lowered ejection fraction of the left ventricle (40%) with regional left ventricular contractility abnormalities, a small volume of pericardial fluid with a mobile fibrin strands, lack of signs of acute pulmonary embolism, normal sized ascending aorta without dissection were found. A chest computed tomography revealed fluid in the pericardial sac highly suggestive of the clotted blood, dissection of normal sized ascending aorta , a non-dissected aneurysm of the aortic arch and a saccular dilatation of the non-dissected proximal segment of the thoracic aorta. The acute aortic dissection is a life - threatening condition demanding immediate diagnosis. The clinical manifestation of this vascular pathology is sometimes a challenge and dependent on the section of the affected aorta. The conventional imaging instrumentation such as transthoracic echocardiography does not always guarantee high diagnostic accuracy of the disease. The transesophageal echocardiography is not always accessible in the emergency departments. D-dimers level and other hemostatic parameters can be a useful screening tool to identify patients with an unusual course of acute aortic dissection.