Clinical Features and Differential Diagnosis of Aortic Dissection: Experience With 236 Cases (1980 Through 1990)

Spittell, Peter C.; Spittell, John A.; Joyce, John W.; Tajik, A. Jamil; Edwards, William D.; Schaff, Hartzell V.; Stanson, Anthony W.

doi:10.1016/s0025-6196(12)60599-0

Cited by 487 publications

(351 citation statements)

References 45 publications

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“…8,10,11 A third group of conditions which sometimes have a STEMI-like presentation are of vascular origin, such as pulmonary embolism and aortic dissection. 12,13 Finally, noncardiac conditions such as acute cholecystitis or pancreatitis may also mimic STEMI. 14,15 Although these conditions simulating STEMI have been described in the literature, in particular in case reports, a contemporary systematic analysis is lacking with regard to the incidence and clinical features of conditions mimicking STEMI in patients referred for primary PCI.…”

mentioning

confidence: 99%

Conditions mimicking acute ST-segment elevation myocardial infarction in patients referred for primary percutaneous coronary intervention

Gu¹,

Svilaas²,

Horst³

et al. 2008

NHJL

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Background/Objectives. A rapid diagnosis of STsegment elevation myocardial infarction (STEMI)is mandatory for optimal treatment. However, a small proportion of patients with suspected STEMI suffer from other conditions. Although case reports have described these conditions, a contemporary systematic analysis is lacking. We report the incidence, clinical characteristics and outcome of patients with suspected STEMI referred for primary percutaneous coronary intervention (PCI) with a final diagnosis other than STEMI.

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mentioning

confidence: 99%

Conditions mimicking acute ST-segment elevation myocardial infarction in patients referred for primary percutaneous coronary intervention

Gu¹,

Svilaas²,

Horst³

et al. 2008

NHJL

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“…Despite availability of several imaging resources, the diagnosis of acute dissection of the aorta remains difficult. In a series of 236 cases, the diagnosis was not suspected at first in 40% of the cases 3 . A report published in 1992 4 of a case series of 186 patients at our institution showed that 30% of the patients with type A dissection died before surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore: a) When the fluid collection reaches 200 to 500 cm 3 , reduction in the voltage of all electrocardiographic waves occurs due to the interposed fluid, the deposited fibrin, and atrophy of the underlying muscle that is compressed. These effects are more evident in the leads of the limbs than in those of the precordium.…”

Section: Discussionmentioning

confidence: 99%

A 73-year-old woman with retrosternal pain but no obstructive coronary artery lesion on coronary angiography

2000

Arq. Bras. Cardiol.

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A 73-year-old woman sought medical assistance at another hospital complaining that she had experienced retrosternal pain that irradiated to the mandible on the day before. She also reported sweating, nausea, vomiting, and dizziness. Acute ischemic heart syndrome was then diagnosed. The laboratory assessment showed the following results: hemoglobin, 12.3g/dL; hematocrit, 36.3%; leukocytes, 11,800/mm 3 (neutrophils, 83%; eosinophils, 4%; lymphocytes, 11%; monocytes, 2%); platelets, 179,000/ mm3; and the following serum values: creatinine, 0.9mg/dL; urea, 68mg/dL; sodium, 140mEq/L; potassium, 4.4mEq/L; total CK, 132 U/L (reference range values: 25 to 170 U/L); MB fraction of creatine kinase, 13 U/L; aspartate aminotransferase (AST), 16 U/L; lactate dehydrogenase 355 U/L (reference range values: 180 to 460 U/L). As part of the medical treatment, a coronary angiography was indicated.On the following day, she had the same symptoms again, and the pain lasted approximately 3 hours. She then sought medical treatment at InCor. She denied other symptoms, arterial hypertension, diabetes mellitus, or dyslipidemia.On physical examination the patient was in regular condition, eupneic, and pale. Her pulse frequency was 76bpm, her blood pressure was 130/60mmHg, and the pulses were symmetrical with normal amplitudes in the limbs. The lungs, heart, and abdomen showed no abnormalities on physical examination.The electrocardiogram showed atrioventricular dissociation with a variation in the shape of the QRS complex, a heart rate of 72bpm, QRS duration of 80 msec, and QRS axis + 30º backwards. The ST segment and the T waves showed plus-minus T waves from V 4 to V 6 ( fig. 1). The chest X-ray (June 7) raised the suspicion of mediastinal enlargement.Serum levels of the MB fraction of creatine kinase 3, 11, 16, and 24 hours after the pain started were, respectively, 11, 7, 4, and 11 U/L. The remaining results of the laboratory assessment are shown in table I.The transthoracic echocardiogram showed a moderate concentric hypertrophy of the left ventricle and normal systolic function (diastolic diameter, 46mm; systolic diameter,

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“…6 Also, MR angiography is of peculiar importance as a noninvasive non-radiating tool for the identification and evaluation of coronary artery anomalies or coronary aneurysms. 7 On the other hand, CMR is the test of choice for certain pericardial diseases, such as non-calcified constrictive pericarditis, tumor invasion of the pericardium, and congenital absence of the pericardium. However, echocardiography provides comparable diagnostic rates and a more increased availability.…”

Section: Clinical Applications Of Cmrmentioning

confidence: 99%

Magnetic Resonance Imaging in Myocardial Fibrosis Related to Ischemic Events

Himcinschi¹,

Beganu²,

Bordi³

et al. 2017

Journal of Interdisciplinary Medicine

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Given the higher amount of detail it offers, the use of magnetic resonance (MR) in the field of cardiology has increased, thus leading to a decrease in the use of invasive and irradiating methods for diagnosing various cardiovascular disorders. The only precautions for MR imaging are metallic implants and advanced-stage chronic kidney disease. For the acquisition of clear and dynamic myocardial images, methods such as spin echo imaging for anatomical description, steady-state free precession imaging for the assessment of ventricular cavity size and function, flow velocity encoding for blood flow measurements, radiofrequency tagging for dynamics, and even spectroscopy for metabolism evaluation are used. Cardiac magnetic resonance (CMR) is considered the gold standard imaging method for the anatomical characterization of the heart and obtaining information related to myocardial dynamics. In case of ischemic events, CMR is used for a detailed description of the necrotic area and the complications, and for tracking the ventricular remodeling. By administrating a contrast agent (gadolinium), the difference between sub-endothelial and transmural infarctions can be distinguished, highlighting even microvascular lesions responsible for the extension of the necrosis. The assessment of the dynamics of ventricular remodeling and viability through late gadolinium enhancement (LGE) technology highlights the area of fibrosis and the occurrence of late complications.

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Clinical Features and Differential Diagnosis of Aortic Dissection: Experience With 236 Cases (1980 Through 1990)

Cited by 487 publications

References 45 publications

Conditions mimicking acute ST-segment elevation myocardial infarction in patients referred for primary percutaneous coronary intervention

Conditions mimicking acute ST-segment elevation myocardial infarction in patients referred for primary percutaneous coronary intervention

A 73-year-old woman with retrosternal pain but no obstructive coronary artery lesion on coronary angiography

Magnetic Resonance Imaging in Myocardial Fibrosis Related to Ischemic Events

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