Aortic aneurysm with complete atrioventricular block and acute coronary syndrome

Abstract

BackgroundAcute aortic dissection (AAD) is a highly lethal and prevalent cardiovascular emergency. AAD can develop into atrioventricular conductivity disorders caused by coronary artery dissection, with acute myocardial infarction (AMI) being the most frequent clinical sign. In many deceased patients, the diagnosis is not confirmed until autopsy, and 85 % receive the wrong therapy as a result of misdiagnosis.Case presentationA 49-year-old male patient presenting with prolonged, intense and sharp precordial pain radiating to his back, as well as cold sweats, nausea and vomiting, was admitted to the cardiac emergency service. Thorax examination revealed normal bilateral breath sounds and a respiratory frequency of 24 incursions/min (SpO2 97 %). Cardiac auscultation revealed a heartbeat that was rhythmic, regular, and bradycardic. There was a visible high-intensity pulsation in the suprasternal notch, a diastolic murmur audible at the aortic focus, and a fourth heart sound on auscultation. The patient was diagnosed with Stanford type A AAD, concomitant complete atrioventricular block, and impairment of the right coronary artery, progressing to acute coronary syndrome (ACS) and spontaneous rupture of the aortic aneurysm. After a hemodynamic study, the patient was transferred for urgent surgical treatment and passed away during the procedure.ConclusionPhysical examination is essential to be able to disregard AAD as the main cause of AMI. The consequences of a misdiagnosis can be fatal if thrombolytic or anticoagulant therapy is chosen as the initial treatment; therefore, surgery is the best treatment for aortic dissection.

Assessment of Tp-Te Interval and Tp-Te/Qt Ratio in Patients with Aortic Aneurysm

“…Aortic stiffness with other risk factors of AA has been accepted as a risk factor for increased major cardiovascular events and some arrhythmia [4], [5]. Some reports have been published about arrhythmic consequences of aortic disease especially acute aortic dissection [6], [7]. However, there is limited information about arrhythmic events and disorders in patients with AA without dissection.…”

“…AA had a complicated pathogenetic process with the degenerative formation and diminished significant aortic distensibility also with substantially increased of aortic wall stress and stiffness which has been demonstrated as a predictor risk factor of increased cardiovascular disease and arrhythmic events [3], [4], [5]. Although there are several case reports about disorders of atrioventricular conductivity in AA with dissection complications, however there is not enough knowledge about arrhythmic disorders in patients with AA without rupture or dissection in the literature [6], [7]. On surface Electrocardiography (ECG) image T wave is inscribed by a sum of opposite voltage gradients in three different cell layers (Epicardial, M and endocardial cells) in the ventricular wall.…”

Determination of the Cytomegalovirus (CMV) infection Role with the Disturbances of Immunoglobulin E (IgE) and Interleukin-33 (IL-33) Concentrations in the Pathogenesis of Asthma and Atherosclerosis in a Sample of Iraqi Patients

“…Evidence from in vitro experiments using animal models suggests that the connections between IgE and mast cells trigger the release of a diversity of substances in a direct or indirect way 25,26 . A study was detected CMV DNA in patients with fatal myocarditis and exposed the detection of CMV DNA in cardiomyocytes in the most samples comparing to the control subjects 27 . Another study was revealed patients with coronary artery disease (CAD) had higher serum IgE levels than those without CAD (p = 0.003), so it proposed as Immunoglobulin E (IgE), play a significant role in allergic reactions, it can be involved in the atherosclerosis development 28 .…”