Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction

Tolefac, Paul Nkemtendong; Dzudie, Anastase; Mouliom, Sidick; Aminde, Leopold; Hentchoya, Romuald; Abanda, Martin Hongieh; Mvondo, Charles Mve; Wanko, Vanina D; Luma, Henry Namme

doi:10.5830/cvja-2017-042

Cited by 2 publications

(3 citation statements)

References 14 publications

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“…AAS can have the same presentation as acute coronary syndrome (ACS). Up to 40% of patients with AAS can have non-specific ST-segment changes, raising the possibility of ischemia and ACS/NSTEMI [ 10 ]. Acute myocardial infarction (AMI) with ST-segment elevation related to the extension of the dissection flap into the ostium of the coronary artery in acute type-A AD develops in 1-2% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…The surgery included an open pericardiotomy with pericardial blood drainage, replacement of the ascending aorta from just above the commissure to the take-off of the innominate artery, partial replacement of the aortic arch, and aortic valve repair with successful results. Multiple intraoperative packed red blood cell units (8), fresh frozen plasma units (4), cryoprecipitate units (10), and platelet apheresis (3) were provided in view of bleeding complications related to the arrival provision of dual antiplatelet and anticoagulation therapy prior to the diagnosis of AD.…”

Section: Case Presentationmentioning

confidence: 99%

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An Unexpected Cause of Chest Pain While Self-Pleasuring: A Ripping Doom Excitement

Escabí-Mendoza¹,

Diaz-Rodriguez²,

Gonzalez-Bravo³

et al. 2023

Cureus

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Acute aortic dissection (AD) involves the tearing of the aortic intima by shearing forces, resulting in a false lumen, which, depending on its location and extent, may lead to hemodynamic compromise, hypoperfusion of vital organs, or even rupture of the aorta. The classical presentation is a sudden chest or back pain described as sharp or ripping in quality. We present a 60-year-old male with a history of hypertension, Liddle’s syndrome, obstructive sleep apnea, and chronic cannabis use for insomnia who arrived at a non-PCI hospital complaining of severe retrosternal chest pain lasting several hours in evolution that started upon masturbation. The pain was ripping in character, starting retrosternally and radiating to his neck and back. After evidence of rising troponin values, he was initially diagnosed with non-ST segment elevation myocardial infarction (NSTEMI), managed with dual antiplatelet therapy with full anticoagulation, and subsequently transferred to our institution for further care. Shortly after his arrival at our hospital, he suddenly deteriorated with recurrent chest pain and hypotension, which triggered an emergent bedside echocardiogram evaluation. This revealed a hemodynamically significant pericardial effusion, moderate to severe aortic valve regurgitation (AR), and an intimal flap visualized on the ascending and descending aorta, suggestive of an extensive AD. A computerized tomographic angiogram confirmed the diagnosis of a Stanford type A AD that required an emergent surgical pericardiotomy, ascending aorta with partial arch replacement, and aortic valve repair. Often, AD may mimic an acute coronary syndrome (ACS) or even present with an acute myocardial infarction (AMI). The appropriate diagnostic imaging evaluation prior to the initiation of anticoagulation therapy should be done in patients with higher-risk clinical criteria for AD to reduce adverse treatment outcomes. The use of a simple three-step diagnostic algorithm for acute aortic syndromes (AAS) may decrease diagnostic delays, misdiagnosis, and inappropriate therapies.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

An Unexpected Cause of Chest Pain While Self-Pleasuring: A Ripping Doom Excitement

Escabí-Mendoza¹,

Diaz-Rodriguez²,

Gonzalez-Bravo³

et al. 2023

Cureus

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“…Penetrating aortic ulcers (PAU), aortic dissection (AD), and intramural hematoma (IMH) are the 3 most serious diseases involving the aorta which are described as acute aortic syndromes (AAS). AD is frequently confused with acute coronary syndrome (ACS), [ 1 – 5 ] but PAU misdiagnosed as ACS is relatively rare. [ 6 ] To our knowledge, only 1 case has been reported (Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

Multiple penetrating aortic ulcers and rupture of superior mesenteric artery branch presenting with symptoms similar to unstable angina

Zhang

Li²,

Zhang³

2018

Medicine

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Ratinale:Penetrating aortic ulcer (PAU) and rupture of a superior mesenteric artery branch is a rare but potentially life-threatening condition.Patient concerns:We describe a case of 73-year-old man was brought to our Emergency Department for intermittent back pain.Diagnoses:The final diagnoses are PAU (Stanford B) and rupture of a branch of the superior mesenteric artery.Interventions:Two covered stents were placed in the thoracic aorta and the right external iliac artery, and the superior mesenteric artery branch was embolized. The patient subsequently underwent exploratory laparotomy, where 6000 to 7000mL of intra-abdominal hematoma was evacuated.Outcomes:After the operation, the patient recovered smoothly and was discharged 20 days later. During 3-year follow-up, the patient did not develop any pain or discomfort.Lessons:Acute aortic syndrome (AAS) and acute coronary syndrome (ACS) may be difficult to distinguish, particularly for elderly patients with extensive atherosclerotic disease. Antithrombotic agent administration should be carefully considered.

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Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction

Cited by 2 publications

References 14 publications

An Unexpected Cause of Chest Pain While Self-Pleasuring: A Ripping Doom Excitement

An Unexpected Cause of Chest Pain While Self-Pleasuring: A Ripping Doom Excitement

Multiple penetrating aortic ulcers and rupture of superior mesenteric artery branch presenting with symptoms similar to unstable angina

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