The wolf in sheep’s clothing: vasovagal syncope in acute aortic dissection

The wolf in sheep’s clothing: vasovagal syncope in acute aortic dissection

Acute aortic dissection, Vasovagal syncope, Painless aortic dissection, Aortic depressor nerve, Risk
stratification, Aortic arch baroreflex

Abstract
Background The presentation of acute aortic dissection can pose a challenge for emergency physicians, as it may
occur without pain. Atypical presentations can lead to significant delays in diagnosis and increased mortality rates.
Case description Our case illustrates that isolated painless syncope can be a rare presenting symptom of acute
aortic dissection type A. What is unique about our case is the limited extension of the dissection tear and the
availability of Holter monitoring during the syncopal episode.
Conclusion This constellation provides insight into the pathophysiological mechanism of the syncope in this patient.
Mechanisms of syncope related to acute aortic dissection are diverse. We show that vasovagal activation not related
to pain can be the underlying mechanism of syncope in acute aortic dissection type A. Although excessive vasovagal
tone in the setting of aortic dissection has been hypothesized in the past, it has never been as clearly illustrated as in
the present case. This also highlights the challenge in risk stratification of syncope in the emergency department.
Keywords Acute aortic dissection, Vasovagal syncope, Painless aortic dissection, Aortic depressor nerve, Risk
stratification, Aortic arch baroreflex

Viviane Donner1,2*, Hadrien Beuret3

, Simon Savoy4

, Vincent Ribordy1,5 and Christine D. Sadeghi4

https://doi.org/10.1186/s12245-024-00664-8

2024

Peri Irawan

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