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A case report of acute myocardial infarction concomitant with Standford type B aortic dissection

Ziyu Zheng1, Zi Ye1, Yingxiong Huang1

  • 1Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, PR China.

Journal of Cardiovascular Disease Research
|March 22, 2014
PubMed

Insights

Misdiagnosing aortic dissection (AD) as acute myocardial infarction (AMI) can be fatal. Early AD detection using risk scores, echocardiography, and D-dimer is crucial before AMI reperfusion therapy.

Area of Science:

  • Cardiology
  • Vascular Surgery

Background:

  • Acute myocardial infarction (AMI) and aortic dissection (AD) co-occurrence is rare but critical.
  • Misdiagnosis as AMI can lead to inappropriate anticoagulant or thrombolytic therapy, worsening outcomes.
  • Stanford type B AD is particularly infrequent in conjunction with AMI.

Purpose of the Study:

  • To highlight a case of diagnostic error due to apparent concordance of AMI symptoms.
  • To emphasize the importance of considering AD in AMI patients.

Main Methods:

  • Case presentation of an 85-year-old male with hypertension and coronary artery disease.
  • Initial diagnosis of non-ST-segment elevation myocardial infarction based on symptoms, enzymes, and ECG.
  • Coronary angiography revealed significant stenosis treated with stents.
  • Computed tomography angiography identified concomitant Stanford type B AD due to persistent symptoms.

Main Results:

  • The patient initially presented with symptoms suggestive of AMI.
  • Coronary angiography confirmed significant coronary artery stenosis, leading to stent placement.
  • Post-procedure, computed tomography angiography revealed an undiagnosed Stanford type B aortic dissection.
  • The patient refused further intervention and died from hemorrhagic shock.

Conclusions:

  • Aortic dissection can precipitate AMI through indirect mechanisms.
  • Thorough investigation for AD is essential before initiating reperfusion therapy for suspected AMI.
  • Tools like the Aortic Dissection Detection Risk Score, transthoracic echocardiography, and D-dimer aid in early AD identification.
Abstract

Keywords:
Acute myocardial infarctionAortic dissectionMisdiagnosis

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