Response

We thank Dr Leung for commenting on our case report¹ and for highlighting the importance of identifying historical factors that might influence how we leverage our clinical decision making and how this, within the context of our case report, might have provided more clinically oriented management pearls. Given the word limitations for the case report, we limited the clinical presentation to pertinent positive accounts offered by the patient during the encounter with the family physician before the emergency department referral. We believed that it was important to present this case in this manner to highlight real-world conditions that often include patients with undifferentiated and “non-classical” presentations of aortic dissection. The reality is that patients often do not present in a classical fashion and, when they do, the differential diagnosis still can be quite lengthy and difficult to sort out without appropriate investigations. Given the spectrum of conditions presenting with chest pain, some potentially lethal as in this case, the process of delivering the best and most timely care might simply be to have a high index of suspicion with a view to arranging further appropriate management, including emergency department referral.

The objective of this case was to highlight the central role of primary care physicians in considering aortic dissection as a cause of chest pain even among patients who might not be considered at high risk and in making decisions around further care.

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