A Rare Case of Acute Stanford Type a Aortic Dissection Presenting with Anterior St-Elevation Myocardial Infarction

Abstract

Introduction
Aortic dissections occur as a result of a tear in the intimal layer, continued longitudinal splitting within the intima and media, and formation of false lumen. This could lead to sudden death or severe aortic regurgitation and cardiogenic shock. The presented case here describes a patient with acute anterior ST-elevation myocardial infarction due to acute Stanford type A ascending aortic dissection.
Case presentation
A 55-year-old male presented with severe chest pain, radiating into the back, jaw, and left arm, and signs of cardiogenic shock. Electrocardiography showed acute anterior ST-elevation myocardial infarction and echocardiography confirmed that there was a reduced left ventricle ejection fraction (38% calculated using the Simpson method), severe aortic regurgitation, and wall motion abnormalities. Based on these findings, we made a diagnosis of acute myocardial infarction. In accordance with the current guidelines, we opted for an interventional therapeutic approach. Angiography showed left main trunk dissection extending to the left anterior descending coronary artery caused by ascending aorta dissection. This finding altered the diagnosis and treatment plan and the patient was immediately sent to the operating room for emergency surgery.
Conclusions
Aortic dissection should be suspected in patients presenting with acute anterior ST-elevation myocardial infarction, severe aortic regurgitation, and cardiogenic shock. Involvement of the left main trunk and left anterior descending artery occurs much more rarely than that of the right coronary artery, which causes inferior myocardial infarction.