P1252 Left ventricular dysfunction masking symptoms of acute aortic dissection in a postpartum woman with peripartum cardiomyopathy: a case study

Abstract

Abstract Acute aortic dissection carries a high mortality rate if left unrecognized and untreated, however only 60-70% of cases are accurately diagnosed in the early stages of hospital admission. This condition rarely occurs in young women but may manifest in the presence of predisposing factors such as pregnancy and preeclampsia; in which hormonal and hemodynamic alterations, exacerbated by high blood pressure, may adversely affect the aortic intima. Acute chest pain in pregnancy may caution physicians and warrant further examination, but left ventricular dysfunction can mask symptoms commonly associated with aortic dissection and delay timely diagnosis. We present a 27-year old woman with acute aortic dissection confounded by peripartum cardiomyopathy. The patient was admitted for respiratory distress ten days after delivery by caesarean section due to severe preeclampsia. She had no complaints of chest or interscapular pain, and initially assessed with peripartum cardiomyopathy. Plain chest radiography showed cardiomegaly without mediastinal widening. Trans-thoracal echocardiography revealed severely reduced left ventricular function and a regurgitant, dilated aortic root with a visible intimal flap. Computed Tomography examination confirmed an aortic dissection Stanford Classification A extending up to the renal arteries. Patients with acute aortic dissection may not always demonstrate classic signs or symptoms, especially when a different entity obscures the progression of disease. Nonetheless, acute aortic dissection is a life-threatening disease, and require immediate recognition. Pregnant women are at a risk towards developing a dissected aorta and different imaging modalities must be promptly utilized, even when present with atypical symptoms, to exclude such catastrophic events.