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Rupturing Abdominal Aneurysm Presenting as Acute Coronary Syndrome
Willeke Van der Stuijt1, Remko S Kuipers2
1Cardiology, Amsterdam University Medical Centers, Amsterdam, NLD.
Insights
Abnormal ECGs and elevated cardiac enzymes can mimic acute coronary syndrome (ACS). This case highlights the critical need to rule out other life-threatening conditions, such as ruptured aortic aneurysms, before treating for ACS.
Area of Science:
- Cardiology
- Vascular Surgery
- Emergency Medicine
Background:
- Acute coronary syndrome (ACS) diagnosis relies on ECG and cardiac enzyme evaluation.
- Abdominal pathologies can present with symptoms mimicking cardiac events.
- Prompt diagnosis and treatment are crucial for life-threatening conditions.
Observation:
- A 61-year-old male presented with upper abdominal pain, ECG abnormalities, and elevated cardiac enzymes.
- Initial assessment focused on excluding cardiac pathology (ACS).
- Clinical deterioration led to emergency laparotomy, revealing a ruptured aortic aneurysm.
Findings:
- Ruptured aortic aneurysm was the underlying cause of the patient's presentation.
- Despite revascularization, the patient experienced multiple organ failure and died.
- The case underscores the potential for non-cardiac conditions to present as ACS.
Implications:
- Clinicians must maintain a high index of suspicion for other critical diagnoses in patients presenting with ACS symptoms.
- Delaying investigation of potential abdominal pathologies can have fatal consequences.
- Integrated diagnostic approaches are essential to differentiate cardiac from non-cardiac emergencies presenting with similar signs.
Abstract:
A 61-year-old male presented to the emergency ward with pain in his upper abdomen. Due to an abnormal electrocardiogram (ECG) and elevated cardiac enzymes the cardiologist was consulted to exclude cardiac pathology. The consulting cardiologist advised to exclude an abdominal diagnosis before treating the condition as an acute coronary syndrome (ACS). Before noninvasive imaging had been performed, the clinical situation deteriorated and an emergency laparotomy revealed a ruptured aortic aneurysm. Despite immediate revascularization multiple organ failure ensued and the patient died a few days later. This case illustrates that the suspicion of ACS should never delay the investigation of other life-threatening disorders. Contrarily angina, ECG abnormalities, and myocardial ischemia are all well known to concur with major vascular, intra-abdominal, intra-cranial, and pulmonary pathology; hence these other life-threatening conditions should always be considered and preferably be ruled out prior to further investigation and treatment of ACS.
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