Case Report

Aortic dissection causing 2 myocardial infarctions

Sebastian Szabo* and Hans Martin Hoffmeister

Published: 16 December, 2019 | Volume 4 - Issue 3 | Pages: 233-235

A 56-year-old man was admitted to our hospital because of sudden onset of right-sided thoracic pain. The ECG showed inferior ST segment elevations. He has been treated with aspirin, clopidogrel, unfractionated heparin and tenecteplase, and his symptoms resolved after 30 minutes. About half an hour later, the patient developed again left-sided thoracic pain and the signs of an anterior myocardial ST-segment elevation infarction. 90 minutes after receiving the initial medications, the performed coronary angiography revealed a long dissection of a large ramus circumflexus. Furthermore, the left anterior descending coronary artery was occluded at about the mid-level. The left ventriculography showed a reduced ventricular function and a Stanford type A aortic dissection. Immediate patient transfer for emergency surgical intervention was arranged. However, ventricular fibrillation occurred during transport and he required endotracheal intubation and prolonged cardiopulmonary resuscitation. Unfortunately, he died during further transport.

In a patient with massive thoracic pain of initially uncommon localization in combination with fluctuation of ST-segment elevations, aortic dissection should be seriously taken into the differential diagnosis as well as into therapeutic management decisions (in particular antiplatelet and thrombolytic therapy).

Read Full Article HTML DOI: 10.29328/journal.jccm.1001074 Cite this Article Read Full Article PDF


Sebastian Szabo, Hans Martin Hoffmeister


  1. Kawahito K, Adachi H, Murata S, Yamaguchi A, Ino T. Coronary malperfusion due to type A aortic dissection: mechanism and surgical management. Ann Thorac Surg. 2003; 76: 1471-1476. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/14602269
  2. Eren E, Toker ME, Tunçer A, Keles C, Erdogan HB, et al. Surgical management of coronary malperfusion due to type a aortic dissection. J Card Surg. 2007; 22: 2-6. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17239202
  3. Neri E, Toscano T, Papalia U, Frati G, Massetti M, Cet al. Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome. J Thorac Cardiovasc Surg. 2001; 121: 552-560. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11241091
  4. Judkins DA, Miller SJ, Capone RJ, Houghton JL. Spontaneous multivessel coronary artery dissection: repeated presentation in a healthy postmenopausal woman. Clin Cardiol. 1999; 22: 677-680. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10526696
  5. Khan NU, Miller MJ, Babb JD, Ahmed S, Saha PK, et al. Spontaneous coronary artery dissection. Acute Card Care. 2006; 8: 162-171. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17012132


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