Volume 2020, Issue 2
  • ISSN: 0253-8253
  • EISSN: 2227-0426


Introduction: Aortic dissection is a cardiovascular emergency with an overall in-hospital mortality rate of 27.4%, and with every hour without intervention, the mortality rate increases by 1%–2% in the first 48 hours. Thoracic aortic dissection typically presents with tearing chest, back, or abdominal pain. Coronavirus disease 2019 (COVID-19) is a viral disease caused by severe acute respiratory syndrome–coronavirus 2 (SARS–Cov2), which has been declared a pandemic by the World Health Organization (WHO) and usually manifests with respiratory symptoms, including cough, shortness of breath, flu-like symptoms, and fever. This case report highlights an important impact of the COVID-19 pandemic on the identification and management of aortic dissection in the emergency department.

Case report: A 35-year-old Bahraini male, a suspected case of Marfan syndrome, presented with complaints of shortness of breath and worsening productive cough after returning from the United States (U.S). He denied any chest, back, or abdominal pain, dizziness, weakness in any limb, gait disturbance, headache, or change in vision. He was considered high risk for COVID-19 because of the recent travel and respiratory symptoms and was diagnosed incidentally with ascending aortic dissection along with a right lung consolidation. His SARS–Cov2 PCR came negative thrice during hospital stay, and he underwent elective cardiothoracic surgery.

Conclusion: The COVID-19 pandemic has been a major stressor for the healthcare system worldwide, inflicting serious threats. Aortic dissection is one of the major life-threatening diseases that needs to be identified early on in the emergency department; however, in this case delayed diagnosis raised significant concerns due to underlying evolving triaging system for COVID-19 and atypical and overlapping clinical presentation. Further research is needed to look for COVID-19–associated factors, affecting the standard of care in the emergency department. Improving handover can directly impact patient care; therefore, it should be optimized.


Article metrics loading...

Loading full text...

Full text loading...



  1. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA. 2000;283(7):897–903. doi: 10.1001/jama.283.7.897. .
  2. Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation 2005;112:3802–13 .
  3. WHO Coronavirus Disease (COVID-19) Dashboard. (n.d.). [cited 18 Aug 2020], Available from: https://covid19.who.int. .
  4. Kadamba AK, Verma A, Sheikh WR, Haldar M, Snehy A, Jaiswal S. Painless acute aortic dissection presenting to the emergency department. J Case Reports. 2019;9(2):100–2. doi: 10.17659/01.2019.002. .
  5. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol. 2015;66(4):350–358. doi: 10.1016/j.jacc.2015.05.029. .
  6. El-Hamamsy I, Brinster DR, DeRose JJ, et al. The COVID-19 pandemic and acute aortic dissections in New York: A matter of public health. J Am Coll Cardiol. 2020;76(2):227–229 .
  7. Chen MH, Rajmane R. A rare life-threatening cause of hemoptysis: Aortic aneurysm dissection. Chest. 2013;144(4):337A .
  8. Reimer AP, Alfes CM, Rowe AS, Rodriguez-Fox BM. Emergency Patient Handoffs: Identifying Essential Elements and Developing an Evidence-Based Training Tool. J Contin Educ Nurs. 2018; 49(1): 34–41. Available online: https://www.healio.com/nursing/journals/jcen/2018-1-49-1/%7Be58bcf3c-ba0d-4baf-bada-db4595dde8e0%7D/emergency-patient-handoffs-identifying-essential-elements-and-developing-an-evidence-based-training-tool .
  9. Coen D, Paolillo C, Cavazza M, et al. Changing Emergency Department and hospital organization in response to a changing epidemic. Emerg Care J. 2020;16(1). doi: 10.4081/ecj.2020.8969. .

Data & Media loading...

  • Article Type: Case Report
Keyword(s): Aortic diseasesAsymptomatic diseasesCoronavirus and Pandemic
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error