Painless type A aortic dissection hiding in bigeminal premature ventricular contractions

Huang, Shih-Chung MD
Tsai, Shi-Hung MD
Tsai, Tsung-Neng MD
Yang, Shih-Ping MD, PhD
Cheng, Shu-Meng MD, PhD

Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei Neihu 114, Taiwan, ROC (Huang, Tsai, Yang, Cheng)
Division of Cardiology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Taipei, Taiwan. ROC (Huang)
Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei Neihu 114, Taiwan, ROC (Tsai)

Received for publication June 15, 2007; accepted July 19, 2007

American Journal of Emergency Medicine 26(1):p 112e1-112e3, January 2008.

Type A aortic dissection is usually difficult to diagnose immediately, especially in pain-free patients, leading to catastrophic outcome. Varied presentations had been reported in previous articles including complete atrioventricular block and supraventricular tachycardia. There were no previous reports regarding painless aortic dissection presenting with bigeminal premature ventricular contractions. Here, we report a case of a 55-year-old man who had syncope with bigeminal premature ventricular contractions on initial electrocardiogram at the emergency department, and finally was diagnosed as having aortic dissection by echocardiography.