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Chest pain in a puerperal woman
  1. C G García,
  2. A C Abadal,
  3. J L Ayerbe

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This case involves a 42 year old woman with a previous history of high blood pressure and pre-eclampsia in her second pregnancy. She was in the seventh postpartum day of her third pregnancy when she was referred because of oppressive thoracic pain, sweating, and amaurosis fugax in the right eye. Physical examination showed a blood pressure of 120/65 mm Hg, a heart rate of 54 beats per minute, and a systolic mesocardial murmur 2/6 with a diastolic component in the aortic focus and a carotid bilateral murmur. An ECG showed sinus rhythm, 60 beats per minute, without ischaemic signs. Chest radiography showed elongation of the aortic arc. Computed tomography (CT) revealed a type A thoracic aortic dissection (panel B), from the aortic valve to the iliac branch, involving both carotid arteries. Transoesophageal echocardiography confirmed the dissection and the entry flap appears above the aortic valve without including the coronary ostia (panel A). Surgical replacement of the ascending thoracic aorta by a Dacron tube was successful, with no neurological damage. The patient remains symptom-free after three years of follow up.

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