A Case of Aortic Dissection Complicating Right Subclavian Artery Occlusion and Mimicking Inferior Myocardial Infarction

Abstract

Introduction: Acute aortic dissection is the most common catastrophic event affecting the aorta. Aortic dissection can present with a wide range of manifestations and is easily misdiagnosed. Case Report: Here we report a case of aortic dissection that was initially misdiagnosed as inferior wall myocardial infarction although the initial symptoms were related to right subclavian artery occlusion caused by a dissection flap. Aortic dissection was diagnosed after the patient underwent coronary angiography. The patient was managed with immediate surgical repair and was discharged in a stable condition.Conclusion: This case report illustrates the importance of having a high index of suspicion for aortic dissection to avoid a mistaken diagnosis in patients with an electrocardiogram (ECG) suggestive of ST elevation myocardial infarction (STEMI)

Keywords

• Aortic dissection, myocardial infarction, subclavian artery occlusion

References

1. Spittell PC, Spittell JA Jr, Joyce JW, Tajik AJ, Edwards WD, Schaff HV, et al. Clinical features and differential diagnosis of aortic dissection: ex- perience with 236 cases (1980 through 1990). Mayo Clin Proc 1993; 68: 642-51. [CrossRef ]
2. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russ- man PL, et al. International Registry of Acute Aortic Dissection (IRAD): New insights from an old disease. JAMA 283: 897-9003. [CrossRef ]
3. Hirst AE Jr, Johns VJ Jr, Kime SW Jr: Dissecting aneurysm of the aorta: A review of 505 cases. Medicine (Baltimore) 1958; 37: 217-79. [CrossRef ]
4. Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Man- agement of acute aortic dissections. Ann Thorac Surg 1970; 10: 237-47. [CrossRef ]
5. Debakey ME, Henly WS, Cooley DA, Morris GC Jr, Crawford ES, Beall AC Jr. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg 1965; 49: 130-49.
6. Park SW, Hutchison S, Mehta RH, Isselbacher EM, Cooper JV, Fang J, et al. Association of painless aortic dissection with increased mortality. Mayo Clin Proc 2004; 79: 1252-7. [CrossRef ]
7. Matsumura JS, Cambria RP, Dake MD, Moore RD, Svensson LG, Snyder S, et al. International controlled clinical trial of the thoracic endovascular aneurysm repair with the Zenith TX2 endovascular graft: 1 year results. J Vasc Surg 2008; 47: 247-57. [CrossRef ]
8. Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, Haverich A, et al. Diagnosis and management of aortic dissection. Eur Heart J 2001; 22: 1642-81. [CrossRef ]

9. Lars G. Svensson E, Stanly C. Aortic dissection in cardiovascular and vas- cular disease of the aorta. WB. Saunders Company Philadelphia 1997; 42-83.
10. Koushima R, Kikuchi Y, Sakurada T, Kusajima K. A case of painless Stand- ford type A acute aortic dissection complicating acute occlusion of the right subclavian artery. Kyobu Geka 1998; 51: 226-30.