Diagnosis of Aortic Dissection Presenting as ST-Elevation Myocardial Infarction using Point-Of-Care Ultrasound

Aortic dissections can present with a broad spectrum of signs and symptoms, making them difficult to diagnose in the emergency department (ED). Aortic dissections can cause occlusion of the coronary arteries, mimicking an acute ST-elevation myocardial infarction (STEMI). Emergency point-of-care ultrasound (POCUS) may be a useful diagnostic tool to help differentiate aortic dissection from a primary myocardial infarction.

A 69-year-old man with no medical history presented to our ED complaining of chest pain. His electrocardiogram revealed new and dynamic ST-segment elevations consistent with a septal myocardial infarction. While the patient was being prepared for the cardiac catheterization laboratory, the treating emergency physician performed a POCUS study. The scan revealed an echogenic flap in the ascending aorta, significant aortic regurgitation, and intimal flaps in the carotid artery and abdominal aorta. The diagnosis of a type A aortic dissection was confirmed with computed tomography angiography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Differentiating an acute STEMI from an aortic dissection can be extremely difficult in the ED. It is important not to delay reperfusion therapy for patients with a true STEMI; however, the same treatment can be lethal for patients with aortic dissection. Emergency POCUS is a fast and accessible test that has been shown to have high specificity for the diagnosis of aortic dissection in the ED. POCUS may be a useful tool to help emergency physicians diagnose aortic dissection presenting with STEMI.