SHM Converge Scientific Abstract ePoster Gallery-Emergent Medical Decision Making: Hiccups and Profound Bradycardia in Painless Descending Aortic Dissection

Emergent Medical Decision Making: Hiccups and Profound Bradycardia in Painless Descending Aortic Dissection

Pdf Summary

A 62-year-old man presented to the ED with sudden generalized weakness, fluctuating somnolence, profound sinus bradycardia, and mild hypotension after working in his yard. He denied chest, back, abdominal, or shortness of breath symptoms, and initial exam, EKG, and chest X-ray were nonspecific. Because of concern for an intracranial cause, he was sent for head CT. During imaging he developed persistent hiccups and new left leg pain and numbness, which raised suspicion for a vascular emergency. A CTA of the thorax, abdomen, and pelvis revealed a Type A aortic dissection extending from the aortic arch to the left common iliac artery, with involvement of the right carotid artery, coronary sinus, abdominal aorta, and left renal artery.<br /><br />The team avoided atropine and pressors due to concern for aortic dissection and proceeded with emergency cardiothoracic surgery. The patient was taken for operative repair and was recovering in the ICU.<br /><br />This case highlights that acute aortic dissection can present atypically, without classic tearing chest pain. Bradycardia may occur from vagal stimulation of the aortic depressor nerve, and hiccups may signal phrenic nerve involvement from dissection extension. Because acute aortic dissection has very high early mortality and is often missed in the ED, clinicians should maintain a high index of suspicion and obtain prompt imaging when atypical but concerning symptoms occur.

Asset Subtitle

Nand Ganesh

Meta Tag

Author List Aaron Fanaee, Joseph Kananen, Nand Ganesh, Sarkis Kouyoumjian

Category Clinical Vignettes

Concept Aortic Dissection

Concept Computed Tomography Angiography

Concept Atypical Presentation

Concept Clinical Clue

Concept Risk Factor

Distinguished Non-Finalist

Presenter Organization Wayne State University School of Medicine

Presenting Author Nand Ganesh

Track Adult

Keywords

aortic dissection

Type A aortic dissection

bradycardia

hiccups

atypical presentation

vascular emergency

CTA imaging

emergency cardiothoracic surgery

sinus bradycardia

aortic depressor nerve

Aortic Dissection

Computed Tomography Angiography

Atypical Presentation

Clinical Clue

Risk Factor