Acute Aortic Dissection Masquerading as Acute Coronary Syndrome: Is Echocardiogram Mandatory before Primary
M A H Khandaker1, J S Kumar, P Panduranga
1Dr Md Azizul Hasan Khandaker, Acting Senior Specialist, Department of Cardiology, National Heart Center, Royal Hospital, Muscat, Sultanate of Oman;
Insights
A patient presenting with chest pain mimicked acute coronary syndrome but had Stanford Type-A Aortic Dissection. Early bedside echocardiography could aid in diagnosing aortic dissection before invasive procedures.
Area of Science:
- Cardiology
- Vascular Surgery
- Emergency Medicine
Background:
- Acute chest pain and ECG changes often suggest acute coronary syndrome (ACS), leading to rapid cardiac catheterization.
- Stanford Type-A Aortic Dissection (AD) can present with symptoms overlapping ACS, posing a diagnostic challenge.
Observation:
- A 58-year-old hypertensive male presented with severe chest pain and palpitations, showing ECG findings suggestive of left main coronary artery occlusion.
- Coronary angiography revealed no stenosis; however, elevated D-dimer and lactate prompted bedside echocardiography.
- Echocardiography identified a dissecting flap in the ascending aorta, confirmed by CT as Stanford Type-A AD.
Findings:
- The patient's initial presentation and ECG were misleading, strongly suggesting coronary artery disease (CAD) rather than aortic dissection.
- Delayed diagnosis of AD occurred due to the initial focus on ACS based on clinical and ECG findings.
Implications:
- Bedside echocardiography before cardiac catheterization may improve early detection of aortic dissection in patients with ACS-like symptoms.
- Integrating rapid echocardiographic assessment into the diagnostic pathway for suspected ACS could prevent delays in critical interventions for AD.
- This case highlights the importance of considering alternative diagnoses, such as AD, even with classic ACS presentations.
Abstract:
A 58-year-old hypertensive man was admitted with severe central chest pain and palpitation. His electrocardiogram (ECG) showed fast atrial fibrillation with features suggestive of left main coronary artery occlusion. He was taken to the Cath-lab but surprisingly, coronary angiogram (CAG) showed no stenosis. Meanwhile, other labs showed high D-dimer and lactate. Hence, bedside Transthoracic echocardiography (TTE) was carried out and showed dissecting flap in the ascending aorta. Immediately, a CT (Computed Tomography) was arranged and it revealed Stanford Type-A Aortic Dissection (AD). Then urgently, he was taken for surgery but unfortunately, he died after long surgical procedure. Here, the misleading factors were that his presentation and ECG changes were so typical of acute coronary syndrome (ACS) that heading us to think about coronary artery disease (CAD). Therefore, the intriguing question: is a bedside echocardiography before shifting to Cath-lab could have given the clue for early detection of AD.
Related Concept Videos
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...