Key result
Type A aortic dissection can mimic a left main ECG pattern without epicardial coronary occlusion.
Why the study?
Acute Stanford type A aortic dissection may mimic left main coronary artery occlusion on ECG yet requires fundamentally different management.
Case Report (n=1)
Acute Stanford type A aortic dissection can mimic left main coronary artery occlusion on ECG, highlighting the critical need for meticulous clinical assessment and imaging to exclude dissection before proceeding to coronary angiography.
Type A dissection with AR and shock may mimic left main ECG changes; extends known pitfalls but leaves open optimal pre-cath imaging strategies.
BACKGROUND: Acute Stanford type A aortic dissection may mimic left main coronary artery occlusion on electrocardiography (ECG) yet requires fundamentally different management. CASE SUMMARY: A 63-year-old woman presented with sudden chest pain, collapse, and cardiogenic shock. ECG showed ST-segment elevation in aVR with diffuse precordial ST-segment depression, suggesting left main coronary occlusion and prompting consideration of urgent coronary angiography. Examination revealed severe aortic regurgitation and a carotid intimal flap. Echocardiography and computed tomography aortography confirmed extensive Stanford type A dissection from the aortic root to the renal arteries with patent coronary ostia. DISCUSSION: This case shows that global subendocardial ischemia from acute severe aortic regurgitation, shock, and malperfusion can reproduce a "left main" ECG pattern without epicardial coronary occlusion. TAKE-HOME MESSAGES: When ECG suggests left main coronary artery occlusion, meticulous clinical assessment and urgent imaging are essential to exclude aortic dissection. The Aortic Dissection Detection Risk Score is a useful tool for identifying high-risk features of acute aortic dissection.
No takes yet. Share an insight, caveat, or question.
Kwok et al. (2026) conducted a case report in Acute Stanford type A aortic dissection (n=1). Acute Stanford type A aortic dissection was evaluated. Acute Stanford type A aortic dissection with severe aortic regurgitation and shock can reproduce a 'left main' ECG pattern without epicardial coronary occlusion.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: