TYPE A AORTIC DISSECTION PRESENTING AS POSITIONAL CHEST PAIN AND DIFFUSE ST-ELEVATIONS ON ELECTROCARDIOGRAM - A DIAGNOSTIC DILEMMA

Document Type

Conference Proceeding

Publication Date

3-7-2023

Publication Title

J Am Coll Cardiol

Abstract

Background: Stanford type A aortic dissection (AD) with concomitant diffuse STEMI is rare. Misdiagnosis may lead to a delay in care or inappropriate loading of antiplatelet therapy.

Case: A 47-year-old male presented to the Emergency Department with 2 days of mid-sternal chest pain. The pain was positional and relieved by sitting up. ECG demonstrated ST-elevation in inferior and anterior leads. The patient was ultimately diagnosed with an acute Type A aortic dissection; but given his chest pain and EKG findings, he was initially loaded with ticagrelor prior to his diagnosis.

Decision-making: An emergent echocardiogram was obtained to assess for ejection fraction and wall motion abnormalities, which demonstrated a Stanford type A aortic dissection with severe aortic regurgitation (Figure 1 A-D demonstrates the dissection flap with concurrent aortic insufficiency). Despite the insensitivity of transthoracic echo in detecting dissection, our study aborted catheterization of his coronaries, which would have potentially worsened outcomes, and triggered urgent surgical consultation. Scanning the proximal aorta using color Doppler resulted in prompt diagnosis with rapid intervention.

Conclusion: Point of care ultrasound to assess for dissection should be used routinely in the emergency department prior to loading with antiplatelet agents.

Volume

81

Issue

8

First Page

3845

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