The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Atypical Coronary Occlusion in a Patient with ST-Elevation Myocardial Infarction Caused by a Masked Aortic Dissection

대동맥 박리에 의한 비정형적 ST분절 상승 심근경색 1예

  • Park, Byoung-Won (Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Seo, Dae-Chul (Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Moon, In-Ki (Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Chung, Jin-Wook (Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Bang, Duk-Won (Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Hyon, Min-Su (Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine) ;
  • Chang, Won-Ho (Department of Chest Surgery, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine)
  • 박병원 (순천향대학교 의과대학 내과학교실) ;
  • 서대철 (순천향대학교 의과대학 내과학교실) ;
  • 문인기 (순천향대학교 의과대학 내과학교실) ;
  • 정진욱 (순천향대학교 의과대학 내과학교실) ;
  • 방덕원 (순천향대학교 의과대학 내과학교실) ;
  • 현민수 (순천향대학교 의과대학 내과학교실) ;
  • 장원호 (순천향대학교 의과대학 흉부외과학교실)
  • Received : 2012.11.08
  • Accepted : 2012.12.20
  • Published : 2013.11.01
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Abstract

ST-elevation myocardial infarction (STEMI) caused by an acute aortic dissection is relatively rare. A diagnosis of dissection can be missed and the situation can become complicated. We report a patient who presented with acute aortic dissection responsible for STEMI related to a dissecting flap into the right coronary artery. This case emphasizes the need for careful assessment of the aorta in cases of atypical coronary occlusion in patients with STEMI without evidence of atherosclerosis in non-culprit coronary segments. The patient was discharged 7 days after primary percutaneous intervention for STEMI. However, she revisited the emergency department for recurrent chest pain and aortic dissection and was diagnosed and managed successfully with surgery.

가슴 통증을 호소한 환자가 심전도에서 ST분절 상승과 비정형적인 관상동맥 폐쇄를 보여 ST분절 상승 심근경색으로 관상동맥 재개통술 시행하였고 이후 퇴원하였으나 가슴통증이 악화되어 재입원하여 대동맥 박리에 의한 심근경색이 진단되었으며 수술적으로 대동맥 박리를 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Spittell PC, Spittell JA Jr, Joyce JW, et al. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clin Proc 1993; 68:642-651. https://doi.org/10.1016/S0025-6196(12)60599-0
  2. Hirata K, Kyushima M, Asato H. Electrocardiographic abnormalities in patients with acute aortic dissection. Am J Cardiol 1995;76:1207-1212. https://doi.org/10.1016/S0002-9149(99)80342-7
  3. Cannesson M, Burckard E, Lefevre M, Bastien O, Lehot JJ. Predictors of in-hospital mortality in the surgical management of acute type A aortic dissections: impact of anticoagulant therapies. Ann Fr Anesth Reanim 2004;23:568-574. https://doi.org/10.1016/j.annfar.2004.03.009
  4. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000;283:897-903. https://doi.org/10.1001/jama.283.7.897
  5. Armstrong WF, Bach DS, Carey LM, Froehlich J, Lowell M, Kazerooni EA. Clinical and echocardiographic findings in patients with suspected acute aortic dissection. AM Heart J 1998;136:1051-1060. https://doi.org/10.1016/S0002-8703(98)70162-0
  6. Shimony A, Filion KB, Mottillo S, Dourian T, Eisenberg MJ. Meta-analysis of usefulness of d-dimer to diagnose acute aortic dissection. Am J Cardiol 2011;107:1227-1234. https://doi.org/10.1016/j.amjcard.2010.12.027
  7. Sakamoto K, Yamamoto Y, Okamatsu H, Okabe M. D-dimer is helpful for differentiating acute aortic dissection and acute pulmonary embolism from acute myocardial infarction. Hellenic J Cardiol 2011;52:123-127.
  8. Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome. J Thorac Cardiovasc Surg 2001;121: 552-560. https://doi.org/10.1067/mtc.2001.112534
  9. Na SH, Youn TJ, Cho YS, et al. Images in cardiovascular medicine: acute myocardial infarction caused by extension of a proximal aortic dissection flap into the right coronary artery: an intracoronary ultrasound image. Circulation 2006;113:e669-671. https://doi.org/10.1161/CIRCULATIONAHA.105.557348
  10. Evangelista A, Flachskampf FA, Erbel R, et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr 2010;11:645-658. https://doi.org/10.1093/ejechocard/jeq056
  11. Masuyama S, Matsuda M, Soeda T, Yuasa S, Shimizu K. Acute type A aortic dissection combined with surgical treatment with acute myocardial infarction. Kyobu Geka 2005;58:861-864.
  12. Sir JJ, Kim YI, Cho WH, Choi SK. Acute myocardial infarction due to aortic dissection. Intern Med 2009;48:173. https://doi.org/10.2169/internalmedicine.48.1726

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