Case Report
 
A unique case of acute aortic dissection mimicking myocardial infarction
Sabah Siddiqui1, Clara N.K. Kwan2, Jose Concepcion3, Bilal A. Malik2, Norbert Moskovits2, Gerald M. Hollander2
1Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
2Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
3Department of Radiology, Maimonides Medical Center, Brooklyn, NY, USA

Article ID: 100043Z09SS2017
doi: 10.5348/Z09-2017-43-CR-15

Corresponding Author:
Clara Ngai Kay Kwan
MD, Department of Cardiology
Maimonides Medical Center
4802 Tenth Avenue
Brooklyn, NY 11219

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How to cite this article
Siddiqui S, Kwan CNK, Concepcion J, Malik BA, Moskovits N, Hollander GM. A unique case of acute aortic dissection mimicking myocardial infarction. J Case Rep Images Med 2017;3:53–57.

Abstract


Introduction: Acute aortic syndrome (AAS) is a rapidly progressive and life-threatening disease of the aorta. Intramural hematoma (IM) is generally held to account for between 5–20% of patients admitted to hospital with the diagnosis of AAS. Acute aortic syndrome may have variable presentations and can mimic myocardial ischemia.
Case Report: We present a case of a 69-year-old male with cardiac risk factors with sudden onset of severe, substernal chest pain radiating to the left shoulder associated with shortness of breath. Electrocardiography showed ST elevations as well as biphasic T waves in anterior lateral leads consistent with an anterior wall myocardial infarction. However, the cardiac catheterization showed normal coronaries. As the patient’s chest pain persisted, an emergent computed tomography scan was performed that revealed an acute IM and underlying Stanford type B dissection. We focus on the difficulty in obtaining a diagnosis, the best diagnostic tools, and management options. Intramural hematoma is best seen on non-enhanced computed tomography scan. Acute dissections involving the ascending aorta are considered surgical emergencies. Uncomplicated IM confined to the descending aorta are treated medically with intensive care unit monitoring, tight blood pressure and pain control.
Conclusion: It is important to have a high index of suspicion for AAD in cases of chest pain. Aortic dissection is one of the differential diagnoses for acute chest pain syndrome, even in the presence of typical electrocardiography changes for acute myocardial infraction.

Keywords: Acute aortic dissection, Acute aortic syndrome, Intramural hematoma


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Author Contributions
Sabah Siddiqui – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for importance intellectual content, Final approval of the version to be published
Clara Kwan – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for importance intellectual content, Final approval of the version to be published
Jose Concepcion – Substantial contributions to conception and design, Drafting the article, Revising it critically for importance intellectual content, Final approval of the version to be published
Bilal A. Malik – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for importance intellectual content, Final approval of the version to be published
Norbert Moskovits – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for importance intellectual content, Final approval of the version to be published
Gerald Hollander – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for importance intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Conflict of Interest
Authors declare no conflict of interest.
Copyright
© 2017 Sabah Siddiqui et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.