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.