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Catheter directed diagnosis of ST-segment elevation myocardial infarction induced by type A aortic dissection: A case

Chi-Yao Huang1,2, Yu-Po Hung1, Tzu-Hsiang Lin1

  • 1Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung.

Medicine
|February 4, 2020
PubMed

Insights

A significant pressure difference between the aorta and radial artery during catheterization can indicate type A aortic dissection (TAAD)-related myocardial infarction. This finding aids early diagnosis of this life-threatening condition.

Area of Science:

  • Cardiovascular Medicine
  • Diagnostic Imaging
  • Emergency Medicine

Background:

  • Type A aortic dissection (TAAD) is a critical condition often presenting with diagnostic challenges.
  • TAAD can involve the coronary arteries, leading to ST-segment elevation myocardial infarction (STEMI).
  • Delayed diagnosis of TAAD-STEMI can result in suboptimal patient management, such as proceeding with primary percutaneous coronary intervention.

Observation:

  • A 58-year-old male presented with chest pain and hypotension, diagnosed with STEMI.
  • During primary percutaneous coronary intervention, a significant pressure gradient (20 mm Hg) was noted between the ascending aorta and radial artery.
  • This pressure differential raised suspicion for TAAD.

Findings:

  • Angiography and CT confirmed TAAD.
  • The patient's outcome was mortality due to extensive dissection and shock.
  • A marked pressure difference between the radial and ascending aortae during catheterization served as a crucial diagnostic clue for TAAD-related myocardial infarction.

Implications:

  • The radial-aortic pressure gradient is a valuable, easily obtainable diagnostic marker for TAAD-STEMI.
  • Early recognition of this pressure differential can expedite diagnosis and appropriate management of aortic dissection.
  • This case highlights the importance of considering TAAD in patients presenting with STEMI and atypical hemodynamic findings.
Abstract

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