Abstract

Aortic dissection with concurrent ST-elevation myocardial infarction (STEMI) is rarely reported. As the proportion of myocardial infarction is higher in the emergency setting compared to aortic dissection, the diagnosis of aortic dissection may be overlooked, and it can be potentially fatal. By using bedside available information, detailed history taking, and multimodality imaging in the emergency setting, it is possible to avoid a mistaken diagnosis. Here, we present a case of aortic aneurysm presenting with anterior STEMI. A 79-year-old woman was admitted to our emergency department with decreased consciousness. Shortly before the patient went unconscious, she had a short episode of dyspnea. Her ECG showed marked ST elevation in the anterior leads. However, her chest radiograph revealed mediastinal widening and a prominent aortic knob. Due to suspicion of aortic dissection from the chest radiograph and loss of consciousness, which may be a sign of malperfusion syndrome of aortic dissection, bedside handheld echocardiography was then performed. It revealed hypokinesis of anterior and anteroseptal walls, pericardial effusion, and dilated aortic root to ascending aorta with severe aortic regurgitation. The presence intimal flap can not be clearly excluded. Based on her imaging and clinical findings, aortic dissection was suspected and thrombolysis was postponed. The patient proceeded to undergo triple-rule-out computed tomography, from which the finding of ascending aortic aneurysm was noted, along with multiple stenosis of LAD (moderate-to-severe) and LCx (moderate), and there was no presence of false lumen. Acute aortic dissection should be considered a differential diagnosis in patients presenting with symptoms suggesting acute coronary syndrome. A suspected case of acute aortic dissection should necessitate further imaging studies. Therefore, multimodality imaging plays a vital role in the emergency setting, as it may avoid fatal consequences of misdiagnosis and mistreatment.

中文翻译：

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动脉瘤患者出现 ST 段抬高型心肌梗死：多模态成像在紧急情况下的作用 — 病例报告

摘要

主动脉夹层并发 ST 段抬高型心肌梗死 (STEMI) 的报道很少。由于与主动脉夹层相比，紧急情况下心肌梗塞的比例更高，因此主动脉夹层的诊断可能会被忽视，并且可能致命。通过在紧急情况下使用床旁可用信息、详细病史采集和多模态成像，可以避免错误诊断。在此，我们介绍一例伴有前 STEMI 的主动脉瘤病例。一名 79 岁的妇女因意识下降被送入我们急诊室。在患者失去知觉前不久，她出现了短暂的呼吸困难。她的心电图显示前导联有明显 ST 段抬高。然而，她的胸部X光片显示纵隔增宽和主动脉瘤突出。由于胸片怀疑主动脉夹层和意识丧失（这可能是主动脉夹层灌注不良综合征的征兆），因此进行了床边手持式超声心动图检查。结果显示前壁和前间壁运动功能减退、心包积液、主动脉根部向升主动脉扩张，并伴有严重的主动脉瓣反流。不能明确排除内膜瓣的存在。根据她的影像学和临床表现，怀疑主动脉夹层，溶栓治疗被推迟。患者继续接受三重排除计算机断层扫描，发现升主动脉瘤，以及 LAD（中度至重度）和 LCx（中度）多处狭窄，并且不存在假性主动脉瘤。流明。对于出现急性冠状动脉综合征症状的患者，应将急性主动脉夹层视为鉴别诊断。疑似急性主动脉夹层病例应进行进一步的影像学检查。因此，多模态成像在紧急情况下发挥着至关重要的作用，因为它可以避免误诊和误治的致命后果。