Key result
Acute aortic dissection mimicking myocardial ischemia requires careful imaging to avoid catastrophic misdiagnosis and inappropriate thrombolytic therapy, with surgery as the primary treatment.
Highlights the diagnostic challenges and management strategies for patients presenting with acute aortic dissection complicated by concomitant acute myocardial infarction.
Heightened suspicion for aortic dissection in MI mimics may avert thrombolysis harm; leaves open prospective validation of imaging algorithms.
Acute aortic dissection an extremely severe condition having a high risk of mortality. The classic symptom may mimic other conditions such as myocardial ischemia, leading to misdiagnosis. Coronary malperfusion associated with aortic dissection is relatively rare, but when it occurs, it may have a fatal result for the patient. The diagnosis of acute coronary syndrome may lead to the inappropriate administration of thrombolytic or anticoagulant treatment resulting in catastrophic consequences. Emergency imaging techniques help to guide the correct diagnosis. Transthoracic echocardiography is useful as a first imaging test, and may be followed by transesophageal echocardiography, or other imaging techniques. Surgery represents the treatment for these patients. However, with the aim to stabilize the patient and to reduce myocardial damage, initial preoperative endovascular coronary intervention has been reported.
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Lentini et al. (2011) conducted a review in Aortic dissection with concomitant acute myocardial infarction. Imaging and surgical management was evaluated. Acute aortic dissection mimicking myocardial ischemia requires careful imaging to avoid catastrophic misdiagnosis and inappropriate thrombolytic therapy, with surgery as the primary treatment.
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