A Case of Acute Type A Aortic Dissection Recovered from Acute Myocardial Ischemia and Malignant Ventricular Tachycardia by Emergency Surgical Treatment.
- Author:
Soo Jung KANG
1
;
Duk Kyung KIM
;
Bang Hun LEE
;
Wook Hyun CHO
;
Sang Hoon LEE
;
Pyo Won PARK
;
Won Ro LEE
Author Information
1. Cardiovasculr Institute, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, College of Medicine, Seoul, Korea.
- Publication Type:Case Report
- Keywords:
acute aortic dissection;
acute myocardial ischemia;
ventricular tachycardia
- MeSH:
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
- From:Korean Journal of Medicine
1998;55(3):405-410
- CountryRepublic of Korea
- Language:Korean
-
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.
