Case Images
A-54-year-old Japanese man with
sudden chest discomfort visited our hospital. Electrocardiography
revealed ST-segment elevation in leadaVR with a mirror image (Picture A).
Echocardiography showed no evidence of pericardial effusion, ascending
aortic flap, or aortic regurgitation, but wall-motion impairment of the
anterior and lateral walls of the left ventricle was observed. Emergency
coronary angiography revealed severe stenosis in the left main trunk
(Picture B). The patient suddenly went into cardiopulmonary arrest, and
percutaneous cardiopulmonary support was initiated. Intravascular
ultrasound showed an extensive false lumen extending around the true
lumen (Picture C). Angiography of the coronary arteries showed untegrade
contrast of the ascending aorta compressed by the false lumen (Picture
D).
In type A acute aortic dissection, ST-segment elevation in leadaVR is a myocardial infarction
complication, and it is the strongest predictor of in-hospital death
(1). If electrocardiography shows this change, the complication of
aortic dissection must always be assumed.
Conflicts of Interest Statement: The authors report no
potential conflicts of interest associated with this research.
Compliance with ethical standards: The patient’s written
informed consent for the publication was obtained by his family, and his
identity has been protected.