Browse > Article
http://dx.doi.org/10.3904/kjm.2013.85.5.516

Atypical Coronary Occlusion in a Patient with ST-Elevation Myocardial Infarction Caused by a Masked Aortic Dissection  

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)
Publication Information
The Korean Journal of Medicine / v.85, no.5, 2013 , pp. 516-520 More about this Journal
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.
Keywords
Dissection, Aorta; Myocardial infarction; Myocardial revascularization;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Hirata K, Kyushima M, Asato H. Electrocardiographic abnormalities in patients with acute aortic dissection. Am J Cardiol 1995;76:1207-1212.   DOI   ScienceOn
2 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.   DOI   ScienceOn
3 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.   DOI   ScienceOn
4 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.   DOI   ScienceOn
5 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.   DOI   ScienceOn
6 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.
7 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.   DOI   ScienceOn
8 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.   DOI   ScienceOn
9 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.
10 Sir JJ, Kim YI, Cho WH, Choi SK. Acute myocardial infarction due to aortic dissection. Intern Med 2009;48:173.   DOI
11 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.   DOI   ScienceOn
12 Evangelista A, Flachskampf FA, Erbel R, et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr 2010;11:645-658.   DOI   ScienceOn