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Type-A aortic dissection manifesting as acute inferior myocardial infarction: 2 case reports

Wenjun Wang1, Jiahong Wu2, Xin Zhao3

  • 1Department of Emergency, Chest Pain Center.

Medicine
|October 26, 2019
PubMed
Abstract

Insights

Acute Type-A aortic dissection (AD) can mimic heart attacks (acute myocardial infarction, AMI). Misdiagnosis can lead to dangerous treatments. Difficulty engaging coronary arteries during catheterization should prompt suspicion of AD.

Area of Science:

  • Cardiology
  • Vascular Surgery

Background:

  • Acute Type-A aortic dissection (AD) presents a significant clinical challenge with high mortality.
  • AD symptoms can overlap with acute myocardial infarction (AMI), leading to diagnostic confusion.

Observation:

  • Two cases are presented where patients with AD were initially misdiagnosed with AMI.
  • Thrombolytic therapy, indicated for AMI, poses severe risks in undiagnosed AD.
  • Diagnostic delays occurred as AD was only identified during cardiac catheterization.

Findings:

  • Computed tomography angiography (CTA) confirmed AD involving the aortic root and coronary ostia in both patients.
  • Emergency aortic root replacement was performed.
  • One patient recovered fully, while the other demised post-operatively.

Implications:

  • Clinical vigilance is paramount when AD symptoms resemble AMI.
  • Challenges during coronary angiography, such as failed catheter engagement, should raise suspicion for AD.
  • Prompt diagnosis and intervention are critical for improving outcomes in AD.

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