Aortic dissection with concomitant acute myocardial infarction: From diagnosis to management

Lentini, Salvatore; Perrotta, Sossio

doi:10.4103/0974-2700.82221

Cited by 43 publications

(48 citation statements)

References 35 publications

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“…Some of which have been blindly performed with the injection of ventricular and aortic high pressure angiography, leading to disastrous consequences. [3,4] Patients admitted to hospital with this condition often complain of severe chest pains, but the early imaging tests of echocardiography and MR plus CT were untypical in this case. However, CTnT and CK-Mb were significantly increased and clinicians lack of experience, which resulted in misdiagnosis as myocardial infarction early.…”

Section: Discussionmentioning

confidence: 88%

Early misdiagnosis of acute aortic dissection: A case report and analysis of the causes

Chen

Kong

2016

IJDI

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Type A aortic dissection is a catastrophic clinical entity involving the ascending aorta. In this case report, a patient was admitted to the emergency room with a presentation resembling acute myocardial infarction (AMI) that led to the inappropriate administration of anticoagulant agents or platelet. This is a case report of a 69-year-old male patient with early misdiagnosis and analysis of type A aortic dissection with discussion on the causes of misdiagnosis in light of the literature.

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Section: Discussionmentioning

confidence: 88%

Early misdiagnosis of acute aortic dissection: A case report and analysis of the causes

Chen

Kong

2016

IJDI

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“…Therefore, if when treating AMI patients in the emergency room, especially those with inferior AMI, clinicians should suspect the existence of aortic dissection at the back of the AMI [4]. However, if aortic dissection cannot be diagnosed in the emergency room in such cases, emergent CAG should be performed.…”

Section: Case Reportmentioning

confidence: 99%

“…However, AAD itself sometimes fails to demonstrate any of the classical physical findings, such as a widened mediastinum, aortic regurgitation or the laterality of blood pressure, and up to 30% of patients suffering from AAD are therefore initially suspected to have other conditions [3,4].…”

Section: Case Reportmentioning

confidence: 99%

The role of intravascular ultrasound scan and thin-sliced coronary computed tomography angiography in diagnosing aortic dissection causing acute myocardial infarction

Nagashima¹,

Yanagi²,

Serikawa³

et al. 2014

IJCRI

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Introduction: Acute aortic dissection is a disease of high mortality. the symptoms may mimic other conditions and misdiagnosed, such as acute coronary syndrome, coronary involvement complicates the clinical scenario and increases mortality. case report: We herein report a case of an acute myocardial infarction caused by acute aortic dissection. Without noticing the aortic dissection, we performed emergent coronary angiography, which showed severe stenosis of the proximal right coronary artery. Intravascular ultrasound scan led us to suspect aortic dissection. However, we performed balloon angioplasty because the patient's hemodynamic status was unstable. EcG-gated coronary computed tomography angiography provided a definitive diagnosis, and the patient underwent successful surgical repair of the aortic dissection. conclusion:

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confidence: 99%

“…In cases of AD associated with MI, and coronary artery dissection or compression by the expanding hematoma; treatment with coronary artery stenting or positioning of a coronary perfusion catheter will help to maintain an adequate coronary perfusion, and reduce myocardial ischemia until surgical repair is done (20)(21)(22).…”

mentioning

confidence: 99%

A case of ascending aortic dissection mimicking acute myocardial infarction and complicated with pericardial tamponade

Hawatmeh

Arqoub

Isbitan

et al. 2016

Cardiovasc. Diagn. Ther.

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A 60-year-old male with past medical history of hypertension, presented to emergency department complaining of chest pain for 2 hours, the pain was described as tearing, substernal pain and was radiating to the neck and shoulders and associated with nausea and sweating. Initial vital signs showed Blood pressure of 120/90 mmHg in right arm, and 110/70 mmHg in left arm, Heart rate of 90 beat per minute, Respiratory rate was 18 breath per minute, temperature of 37.6 ℃ and Oxygen saturation of 95% breathing ambient air. Physical exam was significant for jugular venous distension and cardiac exam showed normal heart sounds, an early diastolic murmur, 3/6 in intensity, best heard on left 3 rd intercostal space without radiation, and no S3 or S4 gallop. Initial lab results showed a white blood cell count of 8.1 k/μL, hemoglobin of 12.2 g/dL, platelets of 177 k/μL, creatinine of 1.19 mg/dL, AST of 30 IU/L, ALT of 29 IU/L, initial set of troponin I was 0.02 ng/mL. Twelve lead electrocardiogram (EKG) showed ST segment elevations in inferior leads ( Figure 1). Emergent coronary angiography was done and revealed normal coronary arteries without evidence of dissection ( Figure 2). After the catheter was pulled back across the aortic valve, an aortic root angiogram was performed and showed aortic insufficiency (grade 3), and an aortic dissection flap that started in the ascending aorta and progressed through to the descending aorta ( Figure 3); this was classified as a Stanford type A (DeBakey type I). A bedside transthoracic echocardiogram was also performed after cardiac catheterization, and showed an EF of 40 % with inferior wall hypokinesia, a dilated aortic root with an evidence of intimal tear in the ascending aorta and moderate aortic regurgitation. In addition, mild pericardial effusion was also noted.Vascular surgery team was immediately consulted, and an aortic computed tomography (CT) scan was done and revealed a Stanford type A (DeBakey type I) aortic Abstract: Acute aortic dissection (AD) is the most common life-threatening disorder affecting the aorta with an incidence that ranges between 5 to 30 cases per million people per year. The symptoms of aortic dissection may be variable and can mimic other more common conditions such as myocardial ischemia. We report a case of a 60-year-old male who presented with inferior wall ST-elevation myocardial infarction (MI).Emergent coronary angiography revealed an ascending aortic dissection with normal coronary arteries. In addition, his aortic dissection was complicated with pericardial tamponade. The patient was managed with an immediate surgical repair, after that he had an uncomplicated postoperative course and was discharged in a stable condition. This case report illustrates the importance of having a high index of suspicion for AD in cases of chest pain. If AD is suspected in a patient with acute coronary syndrome (ACS), confirming the diagnosis with the appropriate imaging studies should be done as quickly as possible, as misdiagnosis with ACS may lead to the inappr...

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Aortic dissection with concomitant acute myocardial infarction: From diagnosis to management

Cited by 43 publications

References 35 publications

Early misdiagnosis of acute aortic dissection: A case report and analysis of the causes

Early misdiagnosis of acute aortic dissection: A case report and analysis of the causes

The role of intravascular ultrasound scan and thin-sliced coronary computed tomography angiography in diagnosing aortic dissection causing acute myocardial infarction

A case of ascending aortic dissection mimicking acute myocardial infarction and complicated with pericardial tamponade

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