Acute Stanford type A aortic dissection with the “giant R wave” electrocardiogram pattern: a case report

Abstract

Background: Stanford type A aortic dissection (TAAD) is a life-threatening cardiovascular event with a significantly high mortality rate if not promptly treated. The “giant R wave” electrocardiogram(ECG) pattern is a dangerous ECG pattern associated with ST-elevation myocardial infarction (MI), most commonly involving occlusion of the left main coronary artery, which carries a high risk of cardiac arrest, cardiogenic shock, and ventricular fibrillation. The concurrence of acute TAAD and MI with the “giant R wave” ECG pattern is an extremely rare condition. Case presentation: A 47-year-old male admitted to the emergency department (ED) with complaints of sudden severe pain behind the sternum, which was diagnosed as acute TAAD, with coronary artery involved, and the ECG shows "giant R wave" pattern accompanied by ST-segment elevation in I, aVL, V2-5 leads. The management should be aggressive with reperfusion via percutaneous intervention in order to race against time for subsequent surgery of TAAD. However, the patient’s condition rapidly deteriorated, presenting with cardiovascular events including cardiogenic shock and cardiac arrest. Despite prompt intervention, the patient unfortunately succumbed to his condition. Conclusions: TAAD with coronary artery involvement is a dangerous condition with high mortality, TTE or computed tomography angiography are important examinations especially when patient with high D-dimer levels, they can help to reduce misdiagnosis. In such case, aggressive with reperfusion via percutaneous intervention to obtain stable vital signs, in order to race against time for subsequent surgery of TAAD maybe the first-line choice.