A case of ascending aortic dissection mimicking acute myocardial infarction and complicated with pericardial tamponade

Free‐wall perforation of the left ventricle after acute myocardial infarction complicated with pericardial tamponade that mimicked ascending aortic dissection: A case report

Life‐threatening cardiac events may be misdiagnosed as acute aortic dissection because of notable symptom mimicry. We report the case of a 72‐year‐old male patient with presentations presumed to be of aortic origin. However, surgery revealed posterior free‐wall perforation in the left ventricle caused by the occlusion of an obtuse marginal branch.

Multiple penetrating aortic ulcers and rupture of superior mesenteric artery branch presenting with symptoms similar to unstable angina: A case report

RATINALE

Penetrating aortic ulcer (PAU) and rupture of a superior mesenteric artery branch is a rare but potentially life-threatening condition.

PATIENT CONCERNS

We describe a case of 73-year-old man was brought to our Emergency Department for intermittent back pain.

DIAGNOSES

The final diagnoses are PAU (Stanford B) and rupture of a branch of the superior mesenteric artery.

INTERVENTIONS

Two covered stents were placed in the thoracic aorta and the right external iliac artery, and the superior mesenteric artery branch was embolized. The patient subsequently underwent exploratory laparotomy, where 6000 to 7000mL of intra-abdominal hematoma was evacuated.

OUTCOMES

After the operation, the patient recovered smoothly and was discharged 20 days later. During 3-year follow-up, the patient did not develop any pain or discomfort.

LESSONS

Acute aortic syndrome (AAS) and acute coronary syndrome (ACS) may be difficult to distinguish, particularly for elderly patients with extensive atherosclerotic disease. Antithrombotic agent administration should be carefully considered.

Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction

Acute aortic dissection is the most frequent and deadly presentation of acute aortic syndromes. Its incidence is estimated at three to four cases per 100 000 persons per year. Its clinical presentation may be misleading, with misdiagnosis ranging between 14.1 and 38% in many series. A late diagnosis or absence of early and appropriate management is associated with mortality rates as high as 50 and 80% by the third day and second week, respectively, especially in proximal lesions. We report on the case of a 53-year-old man who presented with type A aortic dissection, misdiagnosed as acute myocardial infarction, who later died on day 12 of hospitalisation. Although a relatively rare condition, poor awareness in Africa probably accounted for the initial misdiagnosis. Thorough investigation of acute chest pain and initiation of clinical registries are potential avenues to curb related morbidity and mortality.

Vascular Causes of Syncope: An Emergency Medicine Review

BACKGROUND

Syncope is a common emergency department (ED) complaint, accounting for 2% of visits annually. A wide variety of etiologies can result in syncope, and vascular causes may be deadly.

OBJECTIVE

This review evaluates vascular causes of syncope and their evaluation and management in the ED.

DISCUSSION

Syncope is defined by a brief loss of consciousness with loss of postural tone and complete, spontaneous recovery without medical intervention. Causes include cardiac, vasovagal, orthostatic, neurologic, medication-related, and idiopathic, and most cases of syncope will not receive a specific diagnosis pertaining to the cause. Emergency physicians are most concerned with life-threatening causes such as dysrhythmia and obstruction, and electrocardiogram is a primary means of evaluation. However, vascular etiologies can result in patient morbidity and mortality. These conditions include pulmonary embolism, subclavian steal, aortic dissection, cerebrovascular disease, intracerebral hemorrhage, carotid/vertebral dissection, and abdominal aortic aneurysm. A focused history and physical examination can assist emergency physicians in determining the need for further testing and management.

CONCLUSIONS

Syncope is common and may be the result of a deadly condition. The emergency physician, through history and physical examination, can determine the need for further evaluation and resuscitation of these patients, with consideration of vascular etiologies of syncope.