Type-A aortic dissection manifesting as acute inferior myocardial infarction

Abstract Rationale: Acute Type-A aortic dissection (AD) is a challenging clinical emergency. Despite advances in diagnosis and surgical techniques, the high surgical mortality rate of the condition persists. As a result of similarities in clinical symptoms, AD can mimic acute myocardial infarction (AMI). In this paper, we report 2 cases of patients with acute AD manifesting as inferior AMI. Patient concerns: Two patients with undetected AD were misdiagnosed with AMI; in such patients, the administration of thrombolytic therapy has disastrous consequences. Diagnoses: The patients were initially diagnosed with AMI in the emergency room, and then diagnosed with AD during catheterization. Interventions: The patients were transferred to the cardiac catheterization laboratory for primary coronary angiography. The initial attempt to selectively engage the coronary ostium was unsuccessful. Subsequent computed tomography angiography (CTA) confirmed AD from the aortic root to the abdominal aorta and dissection violations of the coronary ostium. The patients underwent emergency aortic root replacement. Outcomes: One patient recovered and was discharged 2 weeks later. At a 1-year follow-up examination, CTA indicated that this patient had made a full recovery. The other patient died 6 days after surgery. Lessons: As a result of similarities in clinical symptoms, AD can mimic AMI. Rapid diagnosis and treatment of AD is crucial. Difficulty during catheter engagement should raise the suspicion of acute Type-A AD.