An unusual finding: Aortic dissection in a patient with Aids on antiretroviral Therapy. A case report and review of literature

Abstract

The aorta is said to be dissecting when there is separation of the layers within the aortic wall. It is caused by a circumferential or less frequently, transverse tear of the intima. Even though aortic dissection is relatively uncommon, it is a catastrophic illness that requires early and accurate diagnosis and treatment for patient survival. Human immunodeficiency virus infection is an increasingly important cause of heart disease. Availability of treatment with highly active antiretroviral drugs has prolonged patient’s life expectancy but has also increased the incidence of non-AIDS co-morbid conditions.

Many cardiovascular diseases have been described in HIV infected individuals, among which is aortic involvement which manifest as: aortitis, aneurysms and dissections. HIV infected individuals also suffer from vascular lesions such as large artery vasculopathy secondary to vasculitis and accelerated atherosclerosis of the coronary arteries. Accelerated atherosclerosis has been linked to patients on protease inhibitors used as part of Highly Active Antiretroviral Therapy (HAART) regimen and have also been implicated in a lipodystrophy syndrome. Aortic dissection has a wide range of clinical presentations.

To make the diagnosis of aortic dissection, a high index of suspicion is required, especially in patients with predisposing risk factors, e.g., hypertension, aneurysmal disease of the aorta, or a familial connective tissue disorder. Typically, the patient is a hypertensive male in his 60s, who presented with a history of abrupt onset of chest pain. We present a case of Aortic dissection in HIV patient on ART with background Hypertension.

CASE REPORT A 55-year-old civil servant who is a known RVD patient diagnosed 16 years ago and regular on HAART and diagnosed with hypertension 3 years ago on moduretic presenting with complains of sudden chest pain which was said to be sharp and associated with difficulty in breathing. Symptoms persisted for four days before he was admitted. He is obese with a BMI of 34. He was in respiratory distress, with a regularly irregular pulse and a wide pulse pressure.

Chest X-ray done revealed presence of cardiomegaly and widened mediastinum, ECG findings included sinus tachycardia with features of chamber enlargements and an Echocardiography revealed presence of aortic aneurysm alongside DCM with Pulmonary hypertension. He was initially managed as a case of hypertensive heart disease in failure precipitated by suspected Acute Coronary Syndrome. A CT angiography which was done confirmed a descending aortic aneurysm with presence of dissection. He was reviewed by Cardiothoracic Unit on that account. Unfortunately, surgery could not be done due to unavailability of needed surgical facilities.

He was placed on oral medications and discharged home after adequate counselling to be on regular clinic follow up.