Myocardial infarction and haemorrhagic stroke as a rare presentation of acute aortic dissection: a fatal case report

Abstract

Background Type-A acute aortic dissection (AAD) is an extremely severe condition, having a high risk of mortality. Initial diagnosis can be deceptive, especially in cases with other confounding presentations. Case Summary We present the case of a 60-year-old male with a history of endovascular aortic repair (EVAR) for abdominal aortic dissection, in which the diagnosis of AAD was made, but almost missed, after presenting with stroke signs and left coronary myocardial infarction. Thorough clinical evaluation and point of care ultrasound (POCUS) were fundamental in the diagnosis of the underlying condition, showing the intimal flap in the ascending aorta, aortic insufficiency, and a dissected left common carotid artery. The diagnosis was confirmed with a head and thoracic CT scan, which also showed bilateral haemorrhagic strokes. Treatment options can be limited in cases of AAD with associated complications, and after careful multidisciplinary evaluation life-sustaining therapy was withdrawn and the patient passed away. Discussion Our case depicts the diagnosis challenge presented by cases of AAD. We emphasize the importance of clinical suspicion and POCUS examination for the diagnosis of the underlying condition, as it is frequently missed during first evaluation. We discuss the available literature regarding the prevalence and described mechanisms by which AAD can associate occlusion myocardial infarction, which more commonly involves the right coronary artery, as well as haemorrhagic stroke. We briefly mention management options, which are limited and controversial.