Key result
Angiography for suspected STEMI reveals type A aortic dissection, prompting successful emergency surgery.
Case Report (n=1)
This case highlights that type A aortic dissection can masquerade as an acute ST-elevation myocardial infarction, requiring high clinical suspicion during primary angioplasty.
Warrants vigilance for aortic dissection in STEMI activations; leaves open the need for prospective diagnostic algorithms.
A 50-year-old man collapsed at the roadside with retrosternal pain, shortness of breath and generalised weakness. An ECG in the emergency department was reported as demonstrating ST segment elevation of up to 1.5 mm in leads V1 to V3, leading to a diagnosis of an acute ST-elevation myocardial infarction. He was immediately transferred to the cardiac catheterisation laboratory. Introduction of a coronary catheter produced signs that raised suspicion of aortic dissection. An aortogram revealed a grossly dilated aortic root of 7.3 cm with a type A ascending aortic dissection. The patient was urgently transferred to the cardiothoracic surgical centre and underwent emergency aortic root and ascending aorta replacement. Following a 20-day hospital admission, and postoperative atrial fibrillation, the patient made a steady and full recovery.
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Nandan et al. (2019) conducted a case report in Suspected ST-elevation myocardial infarction / Aortic dissection (n=1). Emergency aortic root and ascending aorta replacement was evaluated on Patient recovery. A 50-year-old man with suspected STEMI was found to have a type A aortic dissection during angiography and made a full recovery following emergency surgery.
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