Sinus tachycardia as a first sign of aortic dissection

Aortic dissection is an uncommon and often life-threatening condition. It usually presents with classic symptoms, such as severe tearing chest pain radiating to the back associated with acute hemodynamic compromise. Painless aortic dissection is often an under-recognized entity. Its incidence is low, but represents an important clinical dilemma that requires physician vigilance and awareness to diagnose and quickly treat patients to decrease the mortality rate. We present the case of a patient with prostate cancer on chemotherapy, who was referred to the emergency room from the oncology clinic because he was found to be tachycardiac without any other major complaints on routine clinical visit. Electrocardiogram showed sinus tachycardia. Computed tomography was performed to rule out pulmonary embolus, and revealed acute aortic rupture into the pericardial space and manifesting as pericardial tamponade.