A Possible Case of Hypertensive Crisis With Aortic Dissection After an Anti-COVID-19 Vaccine

Area of Science:

• Cardiology
• Vascular Surgery
• Vaccinology

Background:

• Aortic dissection is a life-threatening condition often presenting with severe chest or back pain.
• Painless aortic dissections represent approximately 10% of cases, frequently associated with hypertension.
• The widespread use of COVID-19 vaccines necessitates monitoring for potential rare adverse events.

Observation:

• A 65-year-old hypertensive woman developed sudden neurological symptoms and dyspnea post-COVID-19 vaccination.
• The patient presented without typical chest or back pain, indicative of a painless aortic dissection.
• Imaging revealed a penetrating atherosclerotic ulcer in the descending aorta with significant hemothorax.

Findings:

• The patient experienced a painless aortic dissection within minutes of receiving an inactivated COVID-19 vaccine.
• High blood pressure (220 mmHg systolic) was noted, a common comorbidity.
• Successful thoracic endovascular aortic repair (TEVAR) was performed, with the patient recovering well.

Implications:

• This case suggests a potential, albeit rare, association between COVID-19 vaccination and acute aortic dissection.
• It underscores the importance of considering aortic dissection in patients with sudden neurological changes or unexplained symptoms, even without classic pain.
• Further research may be warranted to explore the immunological or physiological mechanisms linking vaccination to aortic events.