Distinguishing Acute Aortic Syndrome from Myocardial Ischemia: A Case of Stanford Type B Aortic Dissection

Vishnuvarthan R S ¹, Valarmathy M ¹, Suresh Babu P ^1*, Karthikeyan C T ¹

This case showed the critical need for differential diagnosis between acute aortic syndrome and myocardial ischemia to ensure timely and effective treatment.

Abstract

Background: Acute aortic syndrome (AAS) is a progressive and life-threatening condition involving the aorta, with aortic dissection (AAD) being a primary manifestation. AAD occurs due to a tear in the intima of the aorta, which can result from either a primary intimal tear or medial hemorrhage. The peak incidence is observed in individuals during their 6th to 7th decade of life. The sudden onset of pain can mimic myocardial ischemia, presenting a diagnostic challenge when patients show ST-segment elevation on electrocardiography. Methods: We present a case involving a 65-year-old male who presented with sudden chest pain and ST-segment elevation on ECG, initially suspected to be myocardial infarction. Cardiac catheterization ruled out myocardial infarction. Further diagnostic imaging using trans thoracic echocardiography and computed tomography (CT) revealed a Stanford type B aortic dissection with associated intramural hematoma. Results: The CT scan confirmed the presence of acute intramural hematoma and aortic dissection. Initial management involved intravenous labetalol for blood pressure control, transitioning to oral antihypertensives after 24 hours. The follow-up CT showed a reduction in the hematoma. The patient’s symptoms resolved, and he was discharged with instructions for close follow-up. Conclusion: AAS, including AAD and intramural hematoma, presents a significant diagnostic challenge due to its potential to mimic other acute conditions like myocardial ischemia. Timely and accurate diagnosis through advanced imaging is crucial for appropriate management. In this case, the successful differentiation of AAS from myocardial infarction and subsequent management improved patient outcomes. Clinicians should maintain a high level of suspicion for AAS in cases of acute chest pain, especially when ECG changes suggest myocardial ischemia, to ensure prompt and effective treatment.

Keywords: Acute aortic syndrome, aortic dissection, myocardial ischemia, intramural hematoma, diagnostic challeng

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