Korean J Med.  1998 Sep;55(3):405-410.

A Case of Acute Type A Aortic Dissection Recovered from Acute Myocardial Ischemia and Malignant Ventricular Tachycardia by Emergency Surgical Treatment

• Kang SJ
• Kim DK
• Lee BH
• Cho WH
• Lee SH
• Park PW
• Lee WR

Abstract

Acute myocardial infarction is a common initial incorrect diagnosis in patients with acute aortic dissection. Distinction between these two conditions could be especially difficult in a patient who has severe chest pain and abnormal ECG findings. The consequence of such a misdiagnosis in the era of thrombolytic therapy could be catastrophic. We report a case of acute type A aortic dissection who was recovered from acute myocardial ischemia and malig nant ventricular tachycardia by emergency surgical treatment. A 54-year-old male patient with no previous cardiac history visited ER because of syncope and severe chest pain of acute onset. Physical examination was normal except for a low blood pressure (90/40 mmHg) and heart rate of 55 beats/min. The ECG showed ST depression and negative T waves in leads II, III, aVF and V4 to 6. A chest X-ray was normal. Acute myocardial infarction complicated by cardiogenic shock was diagnosed. Emergency cardiac catherization was performed. An aortogram demonstrated type A aortic dissection. The patient had a circulatory arrest with ventricular tachycardia and cardiogenic shock. Cardiopulmonary resuscitation was performed for 50 minutes. He underwent emergency surgical correction. The ST segment returned to normal and there was no evidence of myocardial ischemia after these procedures. The postoperative course was unevenful.

Keyword

acute aortic dissection; acute myocardial ischemia; ventricular tachycardia

MeSH Terms

Cardiopulmonary Resuscitation
Chest Pain
Depression
Diagnosis
Diagnostic Errors
Electrocardiography
Emergencies*
Heart Rate
Humans
Hypotension
Male
Middle Aged
Myocardial Infarction
Myocardial Ischemia*
Physical Examination
Shock, Cardiogenic
Syncope
Tachycardia, Ventricular*
Thorax
Thrombolytic Therapy