Aortic Dissection Mimicking Acute Myocardial Infarction / 中山大学学报(医学科学版)

ABSTRACT

@#【Objective】To explore the clinical characteristics of aortic dissection involved in coronary artery in order to avoid misdiagnosis，mistreatment，and take correct treatment methods in time.【Methods】Twelve cases of aortic dissection（AD）manifesting as acute myocardial infarction（AMI）were analyzed retrospectively and followed up.【Results】 A total of 12 cases were enrolled from 288 cases of AD patients，of which 2 cases（16.7%）were inferior wall myocardial infarction，1 cases（8.3%）were anterior wall myocardial infarction，9 cases（75%）were non ST segment elevation myocardial infarction，male patients was significantly predominant over female，leading to the male/female ratio of 3∶1，the age was 43~76（56.9±12.2）years. Up to 66.7% of patients had a history of hypertension. 11 patients（91.7%）were admitted to hospital for different degrees of chest pain，with back pain in 9 cases（75%），syncope in 4 cases（33.3%），hypotension in 6 cases（50%），and irritability in 7 cases（58.3%）. All the myocardial enzymes were positive in the laboratory and significantly elevated D-dimer；3 cases were performed coronary arteriography but not found the opening of coronary artery. AD was confirmed by transthoracic echocardiography and chest CTA. 3 cases of surgery were performed，1 cases failed and died within 24 hours，and 2 cases were successful. The average follow-up 5 hours to 12 months，2 cases survived and the remaining 10 cases died.【Conclusions】Myocardial infarction caused by aortic dissection is rare in clinic ，but it has critical and high mortality rate，and it is easily misdiagnosed，with poor prognosis. Early diagnosis and timely operation can improve the prognosis. In the case of AMI with back pain，irritability，and abnormal rise of D two polymer，the disease should be highly suspected.