No abstract

We present a clinical case of a patient, without previous cardiac history, admitted to the emergency department with chest pain at low probability for coronary artery disease. The first electrocardiogram showed high-risk changes that were mistakenly interpreted as normal; serial electrocardiograms did not show dynamic changes in STsegment or in the T wave. The patient remained asymptomatic and with hemodynamic stability. Ultrasensitive troponin was positive, and echocardiography reported a structurally healthy heart. Finally, the patient was submitted to diagnostic coronary angiography, evidencing involvement of the proximal anterior descending artery. After reviewing again the initial electrocardiogram, it revealed a high-risk pattern (the de Winter).

We present the clinical case of an 80-year-old woman admitted to the emergency department with jaw pain and acute neurovascular impairment with right arm monoparesis, pulse deficit and pallor of the limb, without chest pain as a cardinal symptom. The history of arterial hypertension, aortic stenosis, and clinical manifestation suggested an acute vascular compromise, for which acute aortic syndrome (AAS) was suspected. Chest x-rays revealed mediastinal widening; angio-CT scan confirmed type-A aortic dissection affecting the right subclavian artery (thrombosis). The patient passed away after expectant non-surgical management.