Key result
Administration of a thrombolytic agent (tPA) to a patient with acute type A aortic dissection misdiagnosed as acute myocardial infarction led to cardiogenic shock and subsequent death after surgery.
Case Report (n=1)
No
This case highlights the catastrophic consequences of administering thrombolytic therapy for suspected STEMI in a patient with an unrecognized acute type A aortic dissection.
Thrombolysis in unrecognized type A dissection risks fatal shock; case report leaves open routine imaging to exclude dissection before STEMI therapy.
Inappropriate administration of thrombolytic agents to acute type A aortic dissection patients with acute myocardial infarction could result in catastrophic outcomes. A 38-year-old female patient without any previous cardiac history visited the emergency room due to a severe acute onset of retrosternal chest pain. The ECG showed a complete heart block with a junctional escape rhythm at 33 beats/min and more than 2 mm of ST elevation in the inferior and anterior precordial leads. Because of an acute myocardial infarction, prompt thrombolytic agent (tPA) was administered. The patient had cardiogenic shock and persistent chest pain after the thrombolytic therapy. We performed the transthoracic echocardiography (TTE). The TTE showed a dissection flap just above the aortic valve and akinesia of the inferior wall of the left ventricle. She underwent an emergency surgical correction. However, the patient died due to the failure of weaning from the cardiopulmonary bypass machine. (Korean Circulation J 2004;34(7):795-798)
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Nah et al. (2004) conducted a case report in Acute type A aortic dissection (n=1). Thrombolytic agent (tPA) was evaluated on Clinical outcome. Administration of a thrombolytic agent (tPA) to a patient with acute type A aortic dissection misdiagnosed as acute myocardial infarction led to cardiogenic shock and subsequent death after surgery.
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