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KMID : 0882419980550030405
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Korean Journal of Medicine
1998 Volume.55 No. 3 p.405 ~ p.410
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A Case of Acute Type A Aortic Dissection Recovered from Acute Myocardial Ischemia and Malignant Ventricular Tachycardia by Emergency Surgical Treatment
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Kim Duk-Kyung
Lee Bang-Hun
Cho Wook-Hyun
Lee Sang-Hoon
Park Pyo-Won
Lee Won-Ro
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Abstract
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Acute myocardial infarction is a common initial incorrect diagnosis in patients with
acute aortic dissection. Distinction between these two conditions could be especially
difficult in a patient who has severe chest pain and abnormal ECG findings. The
consequence of such a misdiagnosis in the era of thrombolytic therapy could be
catastrophic.
We report a case of acute type A aortic dissection who was recovered from acute
myocardial ischemia and malignant ventricular tachycardia by emergency surgical
treatment.
A 54-year-old male patient with no previous cardiac history visited ER because of
syncope and severe chest pain of acute onset. Physical examination was normal except
for a low blood pressure (90/40 mmHg) and heart rate of 55 beats/min. The ECG
showed ST depression and negative T waves in leads II, III, aVF and V4 to 6. A chest
X-ray was normal. Acute myocardial infarction complicated by cardiogenic shock was
diagnosed. Emergency cardiac catherization was performed. An aortogram demonstrated
type A aortic dissection. The patient had a circulatory arrest with ventricular
tarchycardia and cardiogenic shock. Cardiopulmonary resuscitation was performed for 50
minutes.
He underwent emergency surgical correction. The ST segment returned to normal and
there was no evidence of myocardial ischemia after these procedures. The postoperative
course was unevenful.
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KEYWORD
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acute aortic dissection, acute myocardial ischemia, ventricular tachycardia,
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