Highlights the importance of considering ruptured abdominal aortic aneurysm as a differential diagnosis in patients presenting with shock and ST-segment elevations, as myocardial ischemia can be secondary to severe hypotension.
Ruptured AAA can mimic STEMI; single case leaves open broader differential evaluation and incidence.
A 63-year-old man presented to an outside hospital with presyncope, back pain, hypotension and inferior ST segment elevations. He received aspirin, ticagrelor and heparin and was transferred to our institution as a Code STEMI (ST-segment elevation myocardial infarction). A coronary angiogram demonstrated multivessel disease but no occlusive lesion for acute intervention. The following day, he developed worsening abdominal/back pain. A CT angiogram (CTA) showed a ruptured infrarenal abdominal aortic aneurysm. He underwent urgent percutaneous endovascular aneurysm repair. CTA on postoperative day (POD) 10 demonstrated a patent stent graft with no endoleak. The patient was discharged on POD 12 in stable condition.
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Li et al. (2022) studied this question.
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