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Myocardial ischaemia secondary to ruptured abdominal aortic aneurysm

Ben Li1, Vikramaditya Prabhudesai2, Mark Wheatcroft1

  • 1Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.

BMJ Case Reports
|February 4, 2022
PubMed

Insights

A patient with ST-segment elevation myocardial infarction (STEMI) symptoms was diagnosed with a ruptured abdominal aortic aneurysm. Urgent endovascular repair was successful, resolving the critical condition.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • ST-segment elevation myocardial infarction (STEMI) can present with atypical symptoms.
  • Abdominal aortic aneurysms (AAAs) are a significant cause of mortality.
  • Ruptured AAAs require prompt diagnosis and intervention.

Observation:

  • A 63-year-old man presented with presyncope, hypotension, and inferior ST elevations, initially treated as STEMI.
  • Coronary angiography revealed multivessel disease but no acute occlusive lesion.
  • Worsening abdominal and back pain led to a CT angiogram (CTA) diagnosis of a ruptured infrarenal abdominal aortic aneurysm.

Findings:

  • The patient underwent urgent percutaneous endovascular aneurysm repair (EVAR).
  • Postoperative CTA confirmed a patent stent graft with no endoleak.
  • The patient was discharged in stable condition on postoperative day 12.

Implications:

  • This case highlights the importance of considering concurrent cardiovascular and aortic emergencies.
  • Endovascular repair is a viable option for ruptured abdominal aortic aneurysms.
  • Multidisciplinary collaboration is crucial for managing complex presentations involving myocardial infarction and aortic emergencies.

Keywords:
healthcare improvement and patient safetyinterventional cardiologyinterventional radiologyischaemic heart diseasevascular surgery

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