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Acute Aortic Dissection Mimicking STEMI in the Catheterization Laboratory: Early Recognition Is Mandatory.

Arrivi A, Tanzilli G, Puddu PE, Truscelli G, Dominici M, Mangieri E - Case Rep Cardiol (2012)

Bottom Line: Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory.A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction.Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Santa Maria University Hospital, 05100 Terni, Italy.

ABSTRACT
Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction. Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting. Recognition of these occurrences in the catheterization laboratory is important to look immediately for surgery.

No MeSH data available.


Related in: MedlinePlus

Angiographic projections in (A) and (B); (A) (35°LAO and 24°CRA): significant length reduction (dashed lines) of the LMCA; (B) (28°RAO and 6°CAU): PCI with implantation of 4.5 × 13 mm BMS on the proximal tract of the LMCA overlapping with the previously implanted stent. CT scan in (C) (axial scanning) and (D) (3D volume rendering reconstruction) whereby aortic dissection involving the LMCA ostium and thrombosis of the coronary aneurism are seen. LAO: left anterior oblique; RAO: right anterior oblique; CRA: cranial; CAU: caudal.
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fig2: Angiographic projections in (A) and (B); (A) (35°LAO and 24°CRA): significant length reduction (dashed lines) of the LMCA; (B) (28°RAO and 6°CAU): PCI with implantation of 4.5 × 13 mm BMS on the proximal tract of the LMCA overlapping with the previously implanted stent. CT scan in (C) (axial scanning) and (D) (3D volume rendering reconstruction) whereby aortic dissection involving the LMCA ostium and thrombosis of the coronary aneurism are seen. LAO: left anterior oblique; RAO: right anterior oblique; CRA: cranial; CAU: caudal.

Mentions: During the current hospitalization, she had severe hypotension (70/50 mmHg) with heart rate of 63 beats/min. The ECG showed diffuse ST segment depression and elevation in lead aVR, suggesting an acute myocardial infarction (AMI) due to possible occlusion of the left main coronary artery (LMCA). Anteroposterior chest X-rays showed no significant widening of the mediastinum. The patient was under double antiplatelet therapy with aspirin 100 mg and clopidogrel 75 mg. Transferred to the laboratory for primary PCI, there was the evidence of subocclusion of the LMCA with patency of the BMS previously implanted in the LAD and closure of the coronary aneurism (Figure 1(D)). LMCA was then stented using a 3.5 × 9 mm BMS (Figure 1(E)). Because of recurrent episodes of ventricular tachycardia, a control angiogram soon after the procedure showed a significant length reduction of LMCA, just prior the implanted stent (Figure 2(A)). Thus, in overlap with the first stent, a second one (BMS 4.5 × 13 mm) was applied in the proximal tract of LMCA (Figure 2(B)).


Acute Aortic Dissection Mimicking STEMI in the Catheterization Laboratory: Early Recognition Is Mandatory.

Arrivi A, Tanzilli G, Puddu PE, Truscelli G, Dominici M, Mangieri E - Case Rep Cardiol (2012)

Angiographic projections in (A) and (B); (A) (35°LAO and 24°CRA): significant length reduction (dashed lines) of the LMCA; (B) (28°RAO and 6°CAU): PCI with implantation of 4.5 × 13 mm BMS on the proximal tract of the LMCA overlapping with the previously implanted stent. CT scan in (C) (axial scanning) and (D) (3D volume rendering reconstruction) whereby aortic dissection involving the LMCA ostium and thrombosis of the coronary aneurism are seen. LAO: left anterior oblique; RAO: right anterior oblique; CRA: cranial; CAU: caudal.
© Copyright Policy - open-access
Related In: Results  -  Collection

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fig2: Angiographic projections in (A) and (B); (A) (35°LAO and 24°CRA): significant length reduction (dashed lines) of the LMCA; (B) (28°RAO and 6°CAU): PCI with implantation of 4.5 × 13 mm BMS on the proximal tract of the LMCA overlapping with the previously implanted stent. CT scan in (C) (axial scanning) and (D) (3D volume rendering reconstruction) whereby aortic dissection involving the LMCA ostium and thrombosis of the coronary aneurism are seen. LAO: left anterior oblique; RAO: right anterior oblique; CRA: cranial; CAU: caudal.
Mentions: During the current hospitalization, she had severe hypotension (70/50 mmHg) with heart rate of 63 beats/min. The ECG showed diffuse ST segment depression and elevation in lead aVR, suggesting an acute myocardial infarction (AMI) due to possible occlusion of the left main coronary artery (LMCA). Anteroposterior chest X-rays showed no significant widening of the mediastinum. The patient was under double antiplatelet therapy with aspirin 100 mg and clopidogrel 75 mg. Transferred to the laboratory for primary PCI, there was the evidence of subocclusion of the LMCA with patency of the BMS previously implanted in the LAD and closure of the coronary aneurism (Figure 1(D)). LMCA was then stented using a 3.5 × 9 mm BMS (Figure 1(E)). Because of recurrent episodes of ventricular tachycardia, a control angiogram soon after the procedure showed a significant length reduction of LMCA, just prior the implanted stent (Figure 2(A)). Thus, in overlap with the first stent, a second one (BMS 4.5 × 13 mm) was applied in the proximal tract of LMCA (Figure 2(B)).

Bottom Line: Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory.A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction.Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Santa Maria University Hospital, 05100 Terni, Italy.

ABSTRACT
Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction. Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting. Recognition of these occurrences in the catheterization laboratory is important to look immediately for surgery.

No MeSH data available.


Related in: MedlinePlus