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Kassab K, Jolly N, Vij A. Middle-Aged Man With Unstable Angina and an Inaccessible Right Coronary Artery. Cureus 2020; 12:e11156. [PMID: 33251064 PMCID: PMC7686933 DOI: 10.7759/cureus.11156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Acute myocardial ischemia and infarction from retrograde dissection of the aortic root into the coronary ostia is a potentially fatal condition. Unrecognized type A aortic dissection at the time of angiography for acute coronary syndrome (ACS) carries a high burden of morbidity and mortality. Cardiac computed tomography angiography (CCTA) has emerged as one of the instrumental tools in the diagnosis of retrograde coronary involvement from type A aortic dissections. We present a case of ACS secondary to retrograde aortic dissection extending into the right coronary artery (RCA) suspected during coronary angiography and confirmed by CCTA. The patient was managed surgically with aortic root replacement and coronary artery bypass grafting.
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Affiliation(s)
- Kameel Kassab
- Cardiology, John H Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Neeraj Jolly
- Cardiology, Rush University Medical Center, Chicago, USA
| | - Aviral Vij
- Cardiology, John H Stroger, Jr. Hospital of Cook County, Chicago, USA
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Cavalcanti LRP, Sá MPBO, Campos JCS, Braga PGB, Perazzo ÁM, Escorel de A. Neto AC, Wanderley LC, Holz BS, Soares AMMN, Zhigalov K, Tsagakis K, Ruhparwar A, Weymann A. Acute Aortic Dissection: an Update. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2020. [DOI: 10.1007/s40138-020-00216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abrams E, Allen A, Lahham S. Aortic Dissection with Subsequent Hemorrhagic Tamponade Diagnosed with Point-of-care Ultrasound in a Patient Presenting with STEMI. Clin Pract Cases Emerg Med 2019; 3:103-106. [PMID: 31061962 PMCID: PMC6497200 DOI: 10.5811/cpcem.2019.1.40869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 09/12/2018] [Accepted: 01/12/2019] [Indexed: 11/11/2022] Open
Abstract
A 58-year-old male with no past medical history presented to the emergency department with sudden onset left lower extremity weakness and central chest pain with radiation to his back. Electrocardiogram revealed an acute inferior and posterior ST-segment elevation myocardial infarction (STEMI). Point-of-care ultrasound (POCUS) demonstrated right ventricular akinesis consistent with infarction, and an intimal defect consistent with an aortic dissection. We determined that cardiothoracic surgery was indicated rather than left-heart catheterization and anticoagulation. Using POCUS we were able to immediately diagnose a dissection of the aortic arch and considerably alter treatment in a patient presenting with STEMI.
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Affiliation(s)
- Eric Abrams
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Angela Allen
- University of California, Irvine, School of Medicine, Irvine, California
| | - Shadi Lahham
- University of California, Irvine, Department of Emergency Medicine, Orange, California
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von Kodolitsch Y, Wilson O, Schüler H, Larena-Avellaneda A, Kölbel T, Wipper S, Rohlffs F, Behrendt C, Debus ES, Brickwedel J, Girdauskas E, Detter C, Bernhardt AM, Berger J, Blankenberg S, Reichenspurner H, Ghazy T, Matschke K, Hoffmann RT, Weiss N, Mahlmann A. Warfarin anticoagulation in acute type A aortic dissection survivors (WATAS). Cardiovasc Diagn Ther 2017; 7:559-571. [PMID: 29302461 DOI: 10.21037/cdt.2017.07.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Early survivors of acute type A aortic dissection (AAAD) remain at risk for late death and late aortic events. However, the frequency and long-term effects of warfarin anticoagulation on long-term outcome in post-surgical AAAD survivors have not been elucidated. Methods Two tertiary care centers performed a retrospective observational cohort study of warfarin anticoagulation in AAAD in 243 persons with early survival of surgical repair (WATAS). Serial postoperative tomographic imaging was available in 106 persons. Results A total of 88 postoperative AAAD survivors (36%) were on long-term warfarin anticoagulation. The indication for anticoagulation was a mechanical aortic prosthesis in 46 (52%), atrial fibrillation in 33 (38%), stroke in 7 (8%), and pulmonary embolism in 1 (1%). The indication for anticoagulation remained unclear in 1 person (1%). Survival and aortic event free survival were 98.3±0.01 and 98.7±0.01 at 1 year, and 76.4±0.03 and 91.8±0.02 at 5 years, respectively, with no differences irrespective of warfarin anticoagulation. Multivariate Cox regression analysis established higher age (P<0.001), and operation extending into the descending aorta (P=0.030) as independent predictors of late death. Follow-up without tomographic imaging independently predicted increased long-term mortality (P<0.001) and lower rates of documented aortic events (P=0.003). Kaplan-Meyer analysis showed a relationship of aortic diameter growth ≥0.5 cm per year with late death (P=0.041) and with late aortic events (P<0.001). However, rapid aortic growth did not relate to warfarin anticoagulation. Conclusions Warfarin anticoagulation is frequent in postsurgical AAAD and it is administered for vital indications. Warfarin anticoagulation does not relate to late mortality or to late aortic events. Rapid aortic growth predicts late mortality and late aortic events, but warfarin anticoagulation is not associated with aortic growth. Follow-up tomographic imaging is mandatory for long-term survival after surgical repair of AAAD.
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Affiliation(s)
- Yskert von Kodolitsch
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Oliver Wilson
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Helke Schüler
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Axel Larena-Avellaneda
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Tilo Kölbel
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Sabine Wipper
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Fiona Rohlffs
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Christian Behrendt
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - E Sebastian Debus
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Jens Brickwedel
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Evaldas Girdauskas
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Christian Detter
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Alexander M Bernhardt
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Jürgen Berger
- Department of Medical Biometry and Epidemiology, the University Hospital Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Hermann Reichenspurner
- Centre of Cardiology and Cardiovascular Surgery, University Heart Center, Hamburg, Germany
| | - Tamer Ghazy
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- University Center for Vascular Medicine and Institute for Diagnostic Radiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Norbert Weiss
- University Center for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Adrian Mahlmann
- University Center for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Lentini S, Perrotta S. Aortic dissection with concomitant acute myocardial infarction: From diagnosis to management. J Emerg Trauma Shock 2011; 4:273-8. [PMID: 21769215 PMCID: PMC3132368 DOI: 10.4103/0974-2700.82221] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 10/31/2010] [Indexed: 12/16/2022] Open
Abstract
Acute aortic dissection an extremely severe condition having a high risk of mortality. The classic symptom may mimic other conditions such as myocardial ischemia, leading to misdiagnosis. Coronary malperfusion associated with aortic dissection is relatively rare, but when it occurs, it may have a fatal result for the patient. The diagnosis of acute coronary syndrome may lead to the inappropriate administration of thrombolytic or anticoagulant treatment resulting in catastrophic consequences. Emergency imaging techniques help to guide the correct diagnosis. Transthoracic echocardiography is useful as a first imaging test, and may be followed by transesophageal echocardiography, or other imaging techniques. Surgery represents the treatment for these patients. However, with the aim to stabilize the patient and to reduce myocardial damage, initial preoperative endovascular coronary intervention has been reported.
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Affiliation(s)
- Salvatore Lentini
- Cardiovascular and Thoracic Department, University Hospital "G. Martino", University of Messina, Messina, Italy
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