J Korean Soc Emerg Med.  2016 Feb;27(1):30-35. 10.0000/jksem.2016.27.1.30.

Clinical Features of Acute Aortic Dissection Patients Initially Diagnosed with ST-segment Elevation Myocardial Infarction

Affiliations
  • 1Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea. wonpia73@naver.com

Abstract

PURPOSE
Acute myocardial infarction (AMI) concomitant with acute aortic syndrome (AAS) is rare but prompt recognition of concomitant AAS is critical, particularly in patients with ST-segment elevation myocardial infarction (STEMI) because misdiagnosis with early thrombolytic or anticoagulant treatment may result in catastrophic consequences. This study examined the clinical features of patients of STEMI concomitant with AAS that may be a diagnostic clue.
METHODS
Between January 1, 2010 and December 31, 2014, 22 patients who had the initial diagnosis of acute coronary syndrome (AMI and unstable angina) and AAS (aortic dissection, intramural hematoma, and ruptured thoracic aneurysm) in our emergency department were reviewed. Among them, 10 patients who were transferred from other hospitals and 4 patients with non-STEMI were excluded, leaving 8 patients of STEMI concomitant with AAS for analysis.
RESULTS
The mean age of study patients was 57.5+/-16.31 years and five patients were Stanford type A and three patients were type B aortic dissection. Six patients had ST-segment elevation in anterior leads and 2 patients in inferior leads. Most patients had acute onset and severe chest pain, but none had dissecting nature chest pain. Serum troponin I was elevated in three patients but all patients had Ddimer elevation. Aortic regurgitation or regional wall motion abnormality was detected in four patients, and widened mediastinum was observed in all study patients.
CONCLUSION
Concomitant AAS might be suspected in patients with STEMI who have elevated D-dimer and widened mediastinum.

Keyword

Aortic dissection; D-dimer; Myocardial infarction; ST-segment

MeSH Terms

Acute Coronary Syndrome
Aortic Valve Insufficiency
Chest Pain
Diagnosis
Diagnostic Errors
Emergency Service, Hospital
Hematoma
Humans
Mediastinum
Myocardial Infarction*
Troponin I
Troponin I
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