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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
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Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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De Winter electrocardiogram pattern due to type A aortic dissection: a case report.

Qing Zhang1, Dong-Dong Yang2, Yi-Fei Xu3

  • 1Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China.

BMC Cardiovascular Disorders
|April 6, 2022
PubMed
Summary

The de Winter electrocardiograph (ECG) pattern, often indicating acute myocardial infarction (AMI), can also signal acute aortic dissection (AD). This case highlights the importance of considering AD in patients with this ECG finding, especially when it involves coronary arteries.

Keywords:
Acute myocardial infarctionAortic dissectionCase reportDe Winter electrocardiogram pattern

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Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Thoracic Surgery

Background:

  • The de Winter electrocardiograph (ECG) pattern is an uncommon presentation of acute myocardial infarction (AMI).
  • Acute aortic dissection (AD) complicating AMI with a de Winter sign is rare and can lead to missed diagnoses.
  • This case involves AD affecting the left main (LM), left anterior descending (LAD), and left circumflex (LCX) coronary arteries.

Observation:

  • A 57-year-old male presented with acute chest pain and a de Winter ECG pattern.
  • Initial diagnosis of AMI was revised to acute AD, confirmed by transthoracic echocardiography (TTE).
  • The patient experienced cardiogenic shock, requiring intervention.

Findings:

  • Percutaneous coronary intervention (PCI) with stent implantation in the LM-LAD and LM-LCX successfully treated the acute coronary occlusion.
  • The patient's hemodynamics stabilized post-PCI, recovering from cardiogenic shock.
  • Two months later, the patient underwent successful ascending aorta replacement surgery.

Implications:

  • The de Winter ECG pattern warrants consideration of AD, particularly when LAD occlusion is suspected.
  • TTE is a valuable screening tool for diagnosing AD in this context.
  • Further research is needed to establish PCI as a viable treatment for AD-induced LAD occlusion when immediate aortic repair is not feasible.