Mohammad Mostafa Ansari-Ramandi^1,, Samaneh Ansari-Ramandi², Mahdi Motaie³

Introduction: Although aortic dissection is not common but its outcome is frequently fatal, and many patients with aortic dissection die before getting to the hospital or any diagnostic testing. The symptoms of aortic dissection can be similar myocardial ischemia, and physical findings in the physical examination of aortic dissection may be absent. Case presentation: A 59 years old male referred to our hospital with right shoulder pain from 3 days before for evaluation of acute coronary syndrome. He had a history of Coronary artery bypass grafting 3 years before and hypertension from 20 years before. On presentation to our hospital he had stable vital signs. In electrocardiography he had T inversion in leads I, avL and v4-v6 which were new changes with respect to his previous electrocardiography. On physical examination he had an early to mid-diastolic murmur in the right sternal border. On transthoracic echocardiography suspicious flap of dissection was seen in the ascending aorta and CT angiography was done for the patient which confirmed the diagnosis. Discussion: In the case presented a catastrophic condition with high mortality has been presented to our hospital with an unusual symptom of the disease and further evaluation with regards to our physical examination has led us to find the diagnosis and have prompt treatment for the patient. Conclusion: It is of great importance to have great clinical suspicion for aortic dissection in patients referring to the hospital with predisposing factors.

aortic dissection, unusual symptom, right shoulder pain