Infarto agudo do miocárdio e dissecção aguda de aorta: um importante diagnóstico diferencial

Abstract

We report on a case of a 54-year-old man suffering from untreated high blood pressure who presented with a hypertensive emergency and target-organ damage. Initially, he was treated for myocardial infarction but later was diagnosed as having a type-A aortic dissection which was successfully operated with adequate control of blood pressure within the first 24 hours. We emphasize the necessity of the differential diagnosis of thoracic pain in the hospital emergency department and the correct treatment of arterial hypertension aiming at a better prognosis over the long term. Descriptors

Aortic aneurysm with complete atrioventricular block and acute coronary syndrome

“…According to the Stanford classification, aneurysms in the ascending aorta are type A and aneurysms not involving the ascending aorta are type B [ 3 ]. Once started, further dissection can be distal, retrograde, or can occur in both directions, advancing in variable lengths [ 4 ].…”

“…As surgery is the best treatment for AAD, the consequences of a misdiagnosis within this syndrome can be fatal if thrombolytic therapy is chosen as the primary treatment. Moreover, 85 % of the patients receive the wrong therapy as a result of misdiagnosis [ 2 , 4 – 6 ]. In a literature review, among 21 cases of AAD that were treated with thrombolytic therapy, early mortality was reported in 71 % cases, of which many deaths were caused by cardiac tamponade [ 9 ].…”

Tratamento cirúrgico de aneurismas e dissecções de aorta torácica por meio da técnica de frozen elephant trunk: revisão de literatura / Surgical treatment of thoracic aortic aneurysms and dissections using the frozen elephant trunk technique: a literature review

“…O aneurisma aórtico, é definido como uma dilatação irreversível que excedeu seu diâmetro normal ou uma dilatação localizada, com diâmetro igual ou maior que 1,5 vezes o diâmetro normal do vaso. (Dias RR;2004). Esta patologia decorre da degeneração das lamelas elásticas da camada adventícia, a degradação de elastina, tem início na camada íntima e média.…”

“…Em fases iniciais de dilatação aórtica, a ruptura de elastina já alcança valores máximos. (Dias RR;2004). Uma desigualdade entre as metaloproteinases, que são responsáveis pela degradação de elastina, de colágeno e de outras proteínas, e de seus inibidores, contribui para a degradação da matriz extracelular da camada média, resultando na formação de aneurismas.…”

Dissecção aguda de aorta como apresentação de emergência hipertensiva

“…It is usually followed by symptoms of sympathetic activity, which may also present dyspnea and pulmonary edema. In proximal dissections, the pain begins in the precordium, spreads to the neck, arms, and jaw before spreading to the back, lumbar region or lower limbs, and it is an important differential diagnosis of acute myocardial infarction [3,4].…”