Thoracic aortic dissection presenting as acute coronary syndrome

Area of Science:

• Cardiology
• Vascular Surgery
• Emergency Medicine

Background:

• Aortic dissection is a life-threatening condition often presenting with severe chest pain.
• Non-ST elevation myocardial infarction (NSTEMI) shares some overlapping symptoms with aortic dissection, complicating diagnosis.

Observation:

• A patient presented with symptoms suggestive of NSTEMI and received standard treatment, including antiplatelet and anticoagulant therapy.
• Despite initial treatment and fluid resuscitation, the patient remained persistently hypotensive.
• Advanced imaging revealed an extensive Stanford type A aortic dissection extending from the aortic root to the iliac arteries.

Findings:

• The patient underwent emergency hemiarch replacement and aortic root repair.
• Surgical intervention resulted in an uneventful recovery.

Implications:

• This case underscores the importance of considering aortic dissection in the differential diagnosis of patients presenting with chest pain, even with initial NSTEMI indicators.
• The case demonstrates that severe aortic dissections can present with atypical or minimal symptoms, emphasizing the need for high clinical suspicion.