Myocardial infarction and haemorrhagic stroke as a rare presentation of acute aortic dissection: a fatal case report.

Autor:	Lasa-Berasain P; Department of Critical Care Medicine, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain., Salas PR; Department of Cardiology, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain., Azparren EE; Department of Critical Care Medicine, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain., Sanz ER; Department of Critical Care Medicine, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain.
Jazyk:	angličtina
Zdroj:	European heart journal. Case reports [Eur Heart J Case Rep] 2023 Oct 24; Vol. 7 (11), pp. ytad529. Date of Electronic Publication: 2023 Oct 24 (Print Publication: 2023).
DOI:	10.1093/ehjcr/ytad529
Abstrakt:	Background: Type A acute aortic dissection (AAD) is an extremely severe condition, having a high risk of mortality. Initial diagnosis can be deceptive, especially in patients with other confounding presentations. Case Summary: We present the case of a 60-year-old male with a history of endovascular aortic repair for abdominal aortic dissection, in whom a diagnosis of AAD was made, but almost missed, after he presented with stroke signs and left coronary myocardial infarction. Thorough clinical evaluation and point-of-care ultrasound (POCUS) were fundamental to the diagnosis of the underlying condition, which showed the intimal flap in the ascending aorta, aortic insufficiency, and a dissected left common carotid artery. The diagnosis was confirmed with a head and thoracic computed tomography scan, which also showed bilateral haemorrhagic strokes. Treatment options can be limited in patients with AAD with associated complications. After a careful multidisciplinary evaluation, life-sustaining therapy was withdrawn and the patient passed away. Discussion: Our case depicts the diagnosis challenge presented by patients with AAD. We emphasize the importance of clinical suspicion and POCUS examination for the diagnosis of the underlying condition, as it is frequently missed during first evaluation. We discuss the available literature regarding the prevalence and described mechanisms by which AAD can associate occlusion myocardial infarction, which more commonly involves the right coronary artery, as well as haemorrhagic stroke. We briefly mention management options, which are limited and controversial. Competing Interests: Conflict of interest: None declared. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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