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Acute aortic dissection (AAD) is a serious medical problem that requires prompt recognition in order to prevent deadly complications. Nevertheless, making the diagnosis can often be challenging. The clinical signs and symptoms of AAD may vary depending on the location of the dissection, leading to subtle differences in the initial patient presentation. Moreover, the classically described signs of blood pressure disparity, pulse deficit, or the presence of a diastolic murmur are often absent. Here, we report a challenging case of AAD in which the patient presented with acute substernal chest pain that resolved after a short period and was associated with hypotension. His bilateral upper and lower extremities were well perfused with symmetrical, palpable pulses. The initial point-of-care ultrasound (POCUS) showed a small pericardial effusion, and a follow-up echocardiogram revealed an ascending aortic flap with aortic root dilation diagnostic of AAD. Our aim is to shed light on the challenge of diagnosing AAD., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alhalaseh et al.)

Brugada syndrome (BrS) is a hereditary channelopathy associated with malignant ventricular arrhythmia and sudden death in individuals with a structurally normal heart. It is characterized by an ST-segment elevation in the precordial leads. Brugada phenocopy (BrP) is a term given to conditions that could result in ST morphologies identical to those found in Brugada syndrome (Brugada pattern electrocardiogram (EKG) changes) without the actual channelopathy responsible for Brugada syndrome. BrP is a rare EKG manifestation of hyperkalemia, commonly seen at high serum levels of potassium, and associated with malignant arrhythmia. Here, we present a case with Brugada pattern EKG changes associated with hyperkalemia and metabolic acidosis, which normalized after correcting the electrolyte abnormalities. In this case, we also wanted to highlight that not all ST-segment elevation is due to myocardial infarction (MI). In young patients with no coronary artery disease (CAD) risk factors, other potential ST elevation causes should be considered., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Greffie et al.)