Unusual changing localization of acute myocardial ischemia in a case of an aortic dissection

Aortic dissection is a life-threatening illness in which early diagnosis and treatment are critical for survival. Subepicardial hematoma is a rare complication of aortic dissection with retrograde propagation, and such a case, of a 62-year-old woman, is presented here. The autopsy showed that the woman suffered an aortic dissection with the formation of a subepicardial hematoma, as a consequence of retrograde aortic dissection propagation, which led to the gradual compression of the coronary arteries and compromised the circulation of the heart. Rising pressure in the subepicardial hematoma produced confusing ECG readings, which changed over time suggesting varying location of myocardial infarct. These ECG findings, together with nonspecific laboratory and other clinical signs, prevented the establishment of a correct diagnosis of aortic dissection in this patient.