• Thilo Witsch, Anna Stephan, Petra Hederer, Hans-Joerg Busch, and Jens Witsch.
• Department of Cardiology and Angiology I, University of Freiburg, Heart Center, Freiburg, Germany.
• J Emerg Med. 2015 Nov 1; 49 (5): 627-9.

BackgroundPatients with medical conditions may present with psychiatric symptoms, which may lead to worse physical health care. Here we present the case of a patient with acute aortic dissection masked by psychiatric symptoms after a stressful event.Case ReportA 29-year-old female medical student presented to the Emergency Department (ED) complaining about the feeling of "hysteria" after an argument with her boyfriend earlier the same day. She did not report other symptoms or pain. Careful physical examination, initially impeded by the patient's agitation, revealed pulseless extremities. Blood gas analysis showed metabolic acidosis. Transthoracic echocardiography and computed tomography ultimately led to the correct diagnosis: Stanford Type-A aortic dissection. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Medical conditions requiring acute diagnostic work-up and therapy may present with psychiatric symptoms. Increased awareness and the use of standardized operating procedures in the ED may prevent fatal misdiagnoses in these patients.Copyright © 2015 Elsevier Inc. All rights reserved.

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