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Case Reports: Rare disease
Rupture of sinus of Valsalva aneurysm: a rare cause of acute ischaemic chest pain in the emergency department
  1. Himanshi Baid,
  2. Nagasubramanyam Vempalli,
  3. Krishna Shukla and
  4. Reshma Asokan
  1. Emergency Medicine, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
  1. Correspondence to Dr Nagasubramanyam Vempalli; nagasubramanyam.em{at}aiimsrishikesh.edu.in

Abstract

Acute chest pain is a leading cause of emergency department (ED) visits in the adult population. However, patients with a life-threatening cause of chest pain comprise only a small fraction, hence identification of those who need immediate intervention is very important. One rare cause is rupture of the aneurysm, which may present with a wide variety of symptomatology, including anginal chest pain. In a busy ED, evaluation of chest pain suggestive of myocardial ischaemia needs to cater to early identification of acute coronary syndrome (ACS), limit over investigating patients for low or intermediate probability of ACS and appropriate decision making for discharge, to reduce ED over boarding. Validated scores for evaluating the low or intermediate probability chest pain like the HEART pathway may miss such rare diagnoses in the absence of ECG changes, requiring high degree of suspicion and individualisation of patient care.

  • Primary Care
  • Pain
  • Radiology (diagnostics)

https://doi.org/10.1136/bcr-2022-249065

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    Footnotes

    • Contributors HB: Conception of the work, management of the case, drafting the article, guarantor of the work and final approval of the version to be published. NV: Conception of the work, drafting the article, critical revision, guarantor of the work and final approval of the version to be published. KS: Collection of the case details, management of the case, formatting the report, and final approval of the version to be published. RA: Interpretation of the case details, critical revision and final approval of the version to be published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.