Syncope as the Initial Manifestation of Acute Aortic Dissection
Year: 2026
Type: conference-paper
Study design: Case Report
Abstract: Introduction Syncope is a common clinical condition with a wide differential diagnosis, ranging from benign to lifethreatening cardiovascular conditions. Acute aortic dissection is a rare but critical cause of syncope and may initially be mistaken for cardiogenic syncope, especially when accompanied by chest pain or severe arterial hypertension. Case Description A 66-year-old woman presented to emergency department (ED) after an episode of unexplained syncope, followed by severe arterial hypertension and acute pain in the left chest area. At the ED serial ECG recordings showed no ischemic changes, coronary angiography excluded acute coronary ischemia. An urgent chest computed tomography (CT) scan demonstrated features of possible aortic intramural hematoma; however, interpretation was limited as imaging was performed according to a pulmonary embolism protocol. A repeat CT scan confirmed acute aortic syndrome (Stanford type A) with an intramural hematoma and signs of impending rupture. The patient was transferred to the cardiac surgery unit, where aortic arch replacement and thoracic endovascular stenting of the descending aorta were performed the following day. One day later, surgical chest closure was completed. The postoperative period was complicated by an ischemic stroke, respiratory failure requiring invasive mechanical ventilation due to ventilator-associated pneumonia, and intermittent third-degree atrioventricular block, for which a DDDR pacemaker was subsequently implanted. Summary In this case syncope was the initial presentation of acute aortic dissection, likely resulting from temporary cerebral hypoperfusion. Diagnostic delay was related to atypical presentation and limited initial aortic assessment. Disease severity and emergent aortic surgery likely contributed to severe postoperative complications, including ischemic stroke, respiratory failure, and persistent high-grade atrioventricular block requiring permanent pacemaker implantation. Conclusions Syncope may be the first and misleading symptom of acute aortic dissection. Early clinical recognition and targeted imaging are essential to prevent diagnostic delay and reduce morbidity.
Authors: Gastilavičiūtė, Lina, Jusis, Ignas
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7159755056