Thoracic aortic dissection presenting as acute coronary syndrome

Jackson, Emma; Stewart, Michael

doi:10.1136/bcr-2013-201904

BMJ Case Reports

2013

DOI: 10.1136/bcr-2013-201904

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Thoracic aortic dissection presenting as acute coronary syndrome

Emma Jackson

Michael Stewart

Abstract: A patient presented with symptoms consistent with non-ST elevation myocardial infarction (NSTEMI) and was given appropriate antiplatelet and anticoagulant therapy. Despite treatment of the NSTEMI and fluid resuscitation the patient remained persistently hypotensive. Further imaging demonstrated an extensive Stanford type A dissection extending from the aortic root to the left common iliac artery. The patient was taken to theatre and had an emergency hemiarch replacement with repair of the aortic root. Post sur… Show more

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Cited by 3 publications

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“… 6 Its clinical presentation may be misleading with misdiagnosis ranging from 14.1 to 38% seen in many series. 7 - 10 …”

mentioning

confidence: 99%

Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction

Tolefac¹,

Dzudie²,

Mouliom³

et al. 2018

CVJA

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SummaryAcute aortic dissection is the most frequent and deadly presentation of acute aortic syndromes. Its incidence is estimated at three to four cases per 100 000 persons per year. Its clinical presentation may be misleading, with misdiagnosis ranging between 14.1 and 38% in many series. A late diagnosis or absence of early and appropriate management is associated with mortality rates as high as 50 and 80% by the third day and second week, respectively, especially in proximal lesions. We report on the case of a 53-year-old man who presented with type A aortic dissection, misdiagnosed as acute myocardial infarction, who later died on day 12 of hospitalisation. Although a relatively rare condition, poor awareness in Africa probably accounted for the initial misdiagnosis. Thorough investigation of acute chest pain and initiation of clinical registries are potential avenues to curb related morbidity and mortality.

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“… 6 Its clinical presentation may be misleading with misdiagnosis ranging from 14.1 to 38% seen in many series. 7 - 10 …”

mentioning

confidence: 99%

Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction

Tolefac¹,

Dzudie²,

Mouliom³

et al. 2018

CVJA

View full text Add to dashboard Cite

show abstract

The frequency of initial misdiagnosis of acute aortic dissection in the emergency department and its impact on outcome

et al. 2016

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We determine the frequency of initial misdiagnosis and inappropriate treatment with antiplatelets/anticoagulants in the emergency department (ED) and the resultant clinical outcomes in patients with acute type A aortic dissection (AAOD). Medical records of patients with a final diagnosis of AAOD admitted from March 2004 through October 2015 to our tertiary-level heart hospital were evaluated. Patients with suspected dissection in ED were compared to those with initial misdiagnosis regarding demographics and clinical presentation, laboratory and echocardiographic findings. Our primary outcome was hospital mortality in two groups. Long-term mortality after discharge was our secondary outcome. Among 189 patients, 47 (24.8 %) were initially misdiagnosed and received antiplatelets/anticoagulants in ED (Group F), and 142 (75.1 %) were appropriately diagnosed in ED (Group T). The mean age in group F was 60.4 ± 15.0 vs. 57.4 ± 16.0 years in group T (p = 0.260). In group F, 70.2 % were male vs. 60.6 % in group T (p = 0.311). Hospital mortality was 48.9 % in group F vs. 43.7 % in group T (p = 0.645). Long-term mortality was significantly higher in group F (55.6 vs. 21.2 %, p = 0.007). Univariate hazard ratio (HR) of initial misdiagnosis for long-term mortality was 2.56 (95 % CI 1.08-6.06, p = 0.031). In multivariate Cox regression analysis with adjustment for age and type of management (surgical/medical), initial misdiagnosis lost its significance for predicting long-term mortality (HR 2.14, 95 % CI 0.89-5.13, p = 0.086). Initial misdiagnosis of AAOD is a common problem. Hospital mortality is not significantly affected by receiving antiplatelets/anticoagulants. Although long-term mortality is higher in patients with initial misdiagnosis, it is not an independent predictor for long-term mortality.

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Impact of Noninvasive Conservative Medical Treatment for Symptomatic Isolated Celiac Artery Dissection

Ichiba

Hara

Yunoki

et al. 2016

Circ J

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Background: There is no definite consensus regarding the management of symptomatic isolated celiac artery dissection (ICAD), and the effect of conservative medical treatment has never been evaluated. Methods and Results:We enrolled 13 consecutive symptomatic ICAD patients without signs of arterial rupture between 2006 and 2015. All patients received noninvasive conservative medical treatment. The epidemiology, radiological findings and prognostic effect of conservative medical treatment on outcomes were retrospectively assessed. ICAD usually developed in middle-aged men around 50 years old who had a history of smoking. The patients typically presented with acute continuous epigastric pain at rest and with abdominal tenderness on physical examination. On enhanced computed tomography at presentation, the false lumen was found to be double-barreled in 2 patients (15.4%), partially thrombosed in 1 (7.7%), and completely thrombosed in 10 (76.9%). Dissection of associated branches was found in the left gastric artery in 1 patient (7.7%), common hepatic artery in 5 (38.5%), and splenic artery in 7 patients (53.8%). Malperfusion was not found in the stomach or liver but was found in the spleen in 4 patients (30.8%). During a median follow-up period of 376 (165-602) days, all patients were alive without any antiplatelet, anticoagulant, endovascular or surgical treatment.Conclusions: Symptomatic ICAD without arterial rupture can be safely treated with conservative medical therapy over the short term. (Circ J 2016; 80: 1445 -1451

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Thoracic aortic dissection presenting as acute coronary syndrome

Cited by 3 publications

References 13 publications

Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction

Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction

The frequency of initial misdiagnosis of acute aortic dissection in the emergency department and its impact on outcome

Impact of Noninvasive Conservative Medical Treatment for Symptomatic Isolated Celiac Artery Dissection

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