Background: Aortic dissection is a rare but life-threatening disease. The most common predisposing cause is chronic hypertension.
Case: A 38-year-old multipara with chronic hypertension was admitted at 38 weeks of gestation reporting new-onset severe chest pain. Cardiac enzymes, blood gases, electrocardiogram, and chest radiograph were normal. The chest pain and the hypertension worsened despite treatment with narcotics. Bedside transesophageal echocardiography revealed aortic dissection. Uneventful cesarean delivery was followed by surgical repair of the aorta.
Conclusion: Aortic dissection should be considered when a pregnant woman presents with preeclampsia superimposed on chronic hypertension and intractable chest pain.