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Ascending aortic dissection presented as inferior myocardial infarction: a clinical and diagnostic mimicry

Ali A Alsaad1, Olufunso W Odunukan2, John Norman Patton2

  • 1Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA.

BMJ Case Reports
|December 22, 2016
PubMed

Insights

Ascending aortic dissection can rarely cause ST segment elevation myocardial infarction (STEMI), mimicking typical heart attacks. Prompt recognition is crucial as management differs significantly, impacting patient outcomes.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Emergency Medicine

Background:

  • Acute ST segment elevation myocardial infarction (STEMI) is commonly linked to coronary thrombosis or plaque rupture.
  • Ascending aortic dissection, a primary cause of acute aortic syndrome, rarely presents as STEMI but has severe consequences.
  • Standard cardiac interventions like emergent cardiac catheterization may increase mortality in patients with aortic dissection.

Observation:

  • This case report details a painless inferior STEMI in a patient with ascending aortic dissection.
  • The inferior STEMI was caused by the right coronary artery being involved as an extension of the ascending aortic dissection.
  • This presentation highlights a rare but critical diagnostic challenge.

Findings:

  • Ascending aortic dissection can manifest as STEMI, particularly inferior STEMI, due to right coronary artery compromise.
  • Painless presentation of STEMI in the context of aortic dissection is possible.
  • The underlying etiology significantly alters the appropriate diagnostic and therapeutic pathways.

Implications:

  • Emergency physicians, cardiologists, and interventionalists must consider ascending aortic dissection in STEMI cases, especially those with atypical presentations.
  • Differentiating between primary coronary events and dissection-induced STEMI is vital for appropriate management and improved patient survival.
  • Protocol-driven care needs to accommodate rare but life-threatening presentations like dissection-associated STEMI.

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