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Aortic aneurysm with complete atrioventricular block and acute coronary syndrome

Moacyr Magno Palmeira1,2,3, Hellen Yuki Umemura Ribeiro4, Yan Garcia Lira4

  • 1Division of Cardiology, Section of Urgency and Emergency, Department of Intensive Care, Fundação Pública Estadual Hospital de Clínicas Gaspar Vianna, 2000 Alferes Costa street, Pedreira, Belém, Pará, 66087-660, Brazil. palmeiramm@ig.com.br.

BMC Research Notes
|May 5, 2016
PubMed

Insights

Acute aortic dissection (AAD) is a life-threatening emergency. Misdiagnosis, often leading to incorrect treatment like thrombolytics, can be fatal. Prompt surgical intervention is crucial for aortic dissection management.

Area of Science:

  • Cardiovascular Medicine
  • Emergency Medicine
  • Thoracic Surgery

Background:

  • Acute aortic dissection (AAD) is a critical cardiovascular emergency with high mortality.
  • Coronary artery dissection in AAD can lead to atrioventricular conduction disorders and acute myocardial infarction (AMI).
  • Misdiagnosis is common, with 85% of deceased patients receiving incorrect therapy, often only identified at autopsy.

Observation:

  • A 49-year-old male presented with severe chest pain radiating to the back, diaphoresis, nausea, and vomiting.
  • Physical examination revealed bradycardia, a suprasternal pulsation, a diastolic murmur, and a fourth heart sound.
  • The patient was diagnosed with Stanford type A AAD, complete atrioventricular block, and right coronary artery impairment, progressing to ACS and aortic aneurysm rupture.

Findings:

  • The case highlights the diagnostic challenges of AAD presenting as AMI.
  • Complete atrioventricular block and coronary artery involvement complicated the presentation of AAD.
  • The patient's condition rapidly deteriorated, leading to aortic aneurysm rupture despite emergency transfer for surgery.

Implications:

  • Thorough physical examination is vital to rule out AAD in patients presenting with AMI.
  • Incorrect initial treatment, such as thrombolysis or anticoagulation, can have fatal consequences in AAD.
  • Urgent surgical intervention is the definitive treatment for aortic dissection to improve patient outcomes.
Abstract

Keywords:
Acute coronary syndromeAortic aneurysmAtrioventricular blockCardiovascular diseases

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