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Stanford Type A Aortic Dissection After Primary Percutaneous Coronary Intervention for Suspected ST-Segment Elevation
Insights
Acute aortic dissection (AAD) can mimic myocardial infarction. Prompt diagnosis using D-dimer, echocardiography, CT angiography, and risk scoring is crucial for chest pain patients, even after coronary interventions.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Acute aortic dissection (AAD) is a rare but serious condition that can present with symptoms similar to acute myocardial infarction (MI).
- AAD can occur post-percutaneous coronary intervention (PCI), posing a diagnostic challenge.
Background:
Acute aortic dissection (AAD) can mimic acute myocardial infarction, and although rare, it may occur after percutaneous coronary intervention.
Case Summary:
A 68-year-old man, a smoker with hypertension, presented with chest pain. Electrocardiogram showed Q waves with mild ST-segment elevation. Myoglobin and D-dimer were mildly elevated. Coronary angiography revealed near-total occlusion of the proximal left anterior descending artery with aneurysmal dilation and severe stenosis of the distal right coronary artery. Emergency percutaneous coronary intervention relieved symptoms, but severe chest-back pain with shock recurred 8 hours later. Computed tomography angiography confirmed Stanford type A dissection with rupture and massive pericardial effusion. Despite surgery and intensive care, the patient died of multiorgan failure.
Discussion:
In atypical acute myocardial infarction, a rapid loop combining D-dimer, bedside echocardiography, computed tomography angiography, and AAD risk scoring may reduce missed diagnoses.
Take-Home Message:
In chest pain patients with aortic dilation, AAD risk remains despite coronary angiography findings.
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