Acute aortic syndrome mimicking anterior wall ST-elevation myocardial infarction

Abstract

We present a case of a 58-year-old man presenting with chest pain irradiating to the back and left arm, history of smoking and untreated hypertension. The anamnesis, symptoms and ECG findings consisting of ST elevation in leads aVR and V1-V2 suggested ST segment elevated myocardial infarction. Performed ECHO examination revealed possible acute aortic dissection. Considering haemodynamic instability, augmentation of chest pain and passing time which was obviously worsening the prognosis patient was submitted to aortography which finally proofed acute aortic dissection. Patient was subsequently transferred to cardiac surgery unit and successfully treated.

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“…Acute aortic syndrome (AAS) is often first symptom, which require quick diagnosis, appropriate therapy to improve extremely unfavorable prognosis [1]. Acute aortic dissection (AAD) risk is approximately 5-30/million [2][3][4] and is major challenge: diagnostic for cardiologists and even greater therapeutic for cardiac surgeons [2]. Completely different immediate reaction requires acute coronary syndrome (ACS).…”

“…Numerous patient cases with initial ACS suspicion finally verified as AAS, e.g. AAD, were described [2,3]. Nineteen out of 820 people with suspected ACS-ST--elevation myocardioal infarction (STEMI) had different diagnosis, including 3 AAD [5].…”