Aortic dissection presenting as concomitant stroke and STEMI

Cook, Jacob; Aeschlimann, Susan E.; Fuh, Annie; Kohmoto, Takushi; Chang, Su-Min

doi:10.1038/sj.jhh.1002208

Cited by 19 publications

(15 citation statements)

References 4 publications

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“…Unfortunately, the morbidity in these patients is high, and mortality reaches nearly fifty percent.Patients with type A dissections should be operated on as soon as possible, and it is important to note that stroke is not a contradiction to surgery[6, 14]. In this present study, the first patient was operated on for a brain stroke in the first week but died a few days after surgery.…”

Section: Third Casementioning

confidence: 90%

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Brain strokes related to aortic aneurysma – the analysis of three cases

et al. 2017

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AbstractBrain stroke connected with aortic blood flow disturbances is a rare disease and its incidence is difficult to assume. Nevertheless, 10-50% of patients with aortic dissection may not experience any pain. In case of 18-30% patients with aortic dissection neurological signs are first disease presentation and among them ischemic stroke is the most common. The most popular aortic dissection classification is with use of Stanford system. Type A involves the ascending aorta and type B is occurring distal to the subclavian artery. Aortic dissection risk factors include hypertension, cystic medionecrosis, bicuspid aortic valve and Marfan’s or Ehlers-Danlos syndrome.

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Section: Third Casementioning

confidence: 90%

“…Aortic dissection risk factors include hypertension, cystic medionecrosis, bicuspid aortic valve and Marfan’s or Ehlers–Danlos syndrome [6]. Aortic dissection is widely categorized according to the Stanford system.…”

Section: Third Casementioning

confidence: 99%

Brain strokes related to aortic aneurysma – the analysis of three cases

et al. 2017

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“…Some may present with features mimicking acute myocardial infarction, heart failure, syncope or stroke symptoms, which may give clues to the extent of the dissection. Rarely in the literature have there been reported cases of concurrent myocardial infarction and stroke 2 3…”

Section: Discussionmentioning

confidence: 99%

Dissecting out the cause: a case of concurrent acute myocardial infarction and stroke

Nguyen

Rajaratnam²

2011

Case Reports

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mentioning

confidence: 99%

“…Bedside echocardiography is a quick noninvasive method to detect wall motion that can be utilized in cases of chest pain when aortic dissection is a concern. Caution should be used in patients with STEMI and suspected AD, as treatment with thrombolysis for STEMI in non-PCI capable hospitals may have catastrophic effects in patients including rupture, expansion and uncontrolled bleeding (16)(17)(18).…”

mentioning

confidence: 99%

A case of ascending aortic dissection mimicking acute myocardial infarction and complicated with pericardial tamponade

Hawatmeh

Arqoub

Isbitan

et al. 2016

Cardiovasc. Diagn. Ther.

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A 60-year-old male with past medical history of hypertension, presented to emergency department complaining of chest pain for 2 hours, the pain was described as tearing, substernal pain and was radiating to the neck and shoulders and associated with nausea and sweating. Initial vital signs showed Blood pressure of 120/90 mmHg in right arm, and 110/70 mmHg in left arm, Heart rate of 90 beat per minute, Respiratory rate was 18 breath per minute, temperature of 37.6 ℃ and Oxygen saturation of 95% breathing ambient air. Physical exam was significant for jugular venous distension and cardiac exam showed normal heart sounds, an early diastolic murmur, 3/6 in intensity, best heard on left 3 rd intercostal space without radiation, and no S3 or S4 gallop. Initial lab results showed a white blood cell count of 8.1 k/μL, hemoglobin of 12.2 g/dL, platelets of 177 k/μL, creatinine of 1.19 mg/dL, AST of 30 IU/L, ALT of 29 IU/L, initial set of troponin I was 0.02 ng/mL. Twelve lead electrocardiogram (EKG) showed ST segment elevations in inferior leads ( Figure 1). Emergent coronary angiography was done and revealed normal coronary arteries without evidence of dissection ( Figure 2). After the catheter was pulled back across the aortic valve, an aortic root angiogram was performed and showed aortic insufficiency (grade 3), and an aortic dissection flap that started in the ascending aorta and progressed through to the descending aorta ( Figure 3); this was classified as a Stanford type A (DeBakey type I). A bedside transthoracic echocardiogram was also performed after cardiac catheterization, and showed an EF of 40 % with inferior wall hypokinesia, a dilated aortic root with an evidence of intimal tear in the ascending aorta and moderate aortic regurgitation. In addition, mild pericardial effusion was also noted.Vascular surgery team was immediately consulted, and an aortic computed tomography (CT) scan was done and revealed a Stanford type A (DeBakey type I) aortic Abstract: Acute aortic dissection (AD) is the most common life-threatening disorder affecting the aorta with an incidence that ranges between 5 to 30 cases per million people per year. The symptoms of aortic dissection may be variable and can mimic other more common conditions such as myocardial ischemia. We report a case of a 60-year-old male who presented with inferior wall ST-elevation myocardial infarction (MI).Emergent coronary angiography revealed an ascending aortic dissection with normal coronary arteries. In addition, his aortic dissection was complicated with pericardial tamponade. The patient was managed with an immediate surgical repair, after that he had an uncomplicated postoperative course and was discharged in a stable condition. This case report illustrates the importance of having a high index of suspicion for AD in cases of chest pain. If AD is suspected in a patient with acute coronary syndrome (ACS), confirming the diagnosis with the appropriate imaging studies should be done as quickly as possible, as misdiagnosis with ACS may lead to the inappr...

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Aortic dissection presenting as concomitant stroke and STEMI

Cited by 19 publications

References 4 publications

Brain strokes related to aortic aneurysma – the analysis of three cases

Brain strokes related to aortic aneurysma – the analysis of three cases

Dissecting out the cause: a case of concurrent acute myocardial infarction and stroke

A case of ascending aortic dissection mimicking acute myocardial infarction and complicated with pericardial tamponade

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