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A male in his 50s with a history of hypertension, heavy smoking, and a strong family history of heart problems presented with different types of chest pain. He experienced tearing-like sensation chest pain recently, but for the past 8 years, he had complained of heavy chest pain that would subside with rest or sublingual ISDN. An electrocardiogram revealed sinus rhythm with QS pattern in V1-V2 and inverted T wave at III and AVF. Echocardiography revealed normal systolic function of the left ventricle, impaired diastolic function, and mid anteroseptal hypokinesis. A thorax CT scan confirmed the presence of a penetrating aortic ulcer (PAU) with a neck size of 20.7 mm and a depth of 16.0 mm after a chest x-ray raised suspicion of descending aorta abnormality. The patient underwent thoracic endovascular aortic repair (TEVAR) with the implantation of a single body stent graft. Additionally, diagnostic coronary angiography revealed three-vessel coronary artery disease.
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