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Acute pericarditis: a presenting manifestation of aortic dissection

A patient presented to the outpatient clinic (non-emergency), with non-exertional retrosternal chest pain of 3 days' duration. The pain was sharp in character and worsened by being in a supine position. The patient had no history of cardiac disease or hypertension and was an active smoker. Phenotypic characteristics of Marfan or Ehlers-Danlos syndrome were absent. On physical examination, the patient had diaphoresis. Vital signs were normal, body temperature was 36.8°C and heart rate was 88 bpm with no dysrhythmia. Blood pressure was 120/70 and 110/70 mm Hg in the right and left arms, respectively. On auscultation, a pericardial friction rub was heard over the left upper sternal border. No cardiac murmurs were noted. Pulses were equal throughout all extremities. Initial ECG (figure 1) showed a normal sinus rhythm. A concave …