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[Aortic dissection--a differential diagnosis in patients with chest pain and ECG changes]

Eigil Fossum1, Bilal Ata, Jan Eritsland

  • 1Hjerte-Lungesenteret, Ullevål universitetssykehus, Oslo. eigil.fossum@ioks.uio.no

Tidsskrift for Den Norske Laegeforening : Tidsskrift for Praktisk Medicin, Ny Raekke
|October 18, 2003
PubMed

Insights

Aortic dissection can mimic myocardial infarction, presenting with chest pain and ECG changes like ST elevation. Consider aortic dissection before administering thrombolytic therapy in such cases.

Area of Science:

  • Cardiology
  • Vascular Surgery

Background:

  • Thrombolytic therapy is standard for myocardial infarction but challenging to differentiate from aortic dissection based on symptoms alone.
  • Aortic dissection, particularly type A, can cause ECG abnormalities mimicking acute coronary syndromes.
  • Distinguishing between these critical conditions is vital for appropriate patient management.

Observation:

  • A retrospective review identified 14 patients with type A aortic dissection between 1999 and March 2001.
  • Of these, only two had normal ECGs; six presented with ST-elevation myocardial infarction (STEMI)-like changes.
  • Two patients received thrombolytic or antithrombotic therapy prior to diagnosis.

Findings:

  • Electrocardiogram (ECG) findings, including ST elevation, are common in type A aortic dissection.
  • Clinical presentation can be misleading, delaying the diagnosis of aortic dissection.
  • Inappropriate thrombolytic therapy may be administered due to misdiagnosis.

Implications:

  • Aortic dissection should be a key differential diagnosis in patients with chest pain and ST elevation.
  • Prompt consideration of aortic dissection can prevent delays in life-saving surgical intervention.
  • This highlights the need for heightened clinical suspicion in emergency settings.
Abstract

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