Aortic arch variant presenting as an acute ST elevation myocardial infarction

Area of Science:

• Cardiology
• Radiology
• Anatomical Pathology

Background:

• Myocardial infarction (MI) diagnosis typically involves ST-segment elevation on ECG and elevated cardiac biomarkers.
• Coronary artery disease is the most common cause of MI, but other factors can precipitate cardiac events.

Observation:

• A woman presented with acute chest pain, ECG changes, and elevated troponin I (TnI), consistent with MI.
• Cardiac catheterization showed non-obstructive coronary arteries, and echocardiography revealed anterior wall hypokinesis.

Findings:

• A CT scan identified a rare anatomical variant: an aberrant right subclavian artery originating from the aortic arch.
• This aortic anomaly was the likely cause of the patient's myocardial infarction symptoms.

Implications:

• This case underscores the necessity of comprehensive diagnostic imaging to rule out rare anatomical abnormalities in MI presentations.
• Recognizing such anomalies is crucial for accurate diagnosis and appropriate management, preventing misdiagnosis of coronary artery disease.