Emergency Medicine: Open Access
Open Access

Abstract

Left Main Acute Myocardial Infarction Associated with Limited Aortic Dissection-Pandora's Box

Andrada Bogdan, Lucian Calmac, Alexandru Scafa-Udriste and Maria Dorobantu

Acute aortic dissection is a relative rare disease which can sometimes mimic acute myocardial infarction, usually inferior, secondary to right coronary artery involvement. Accurate rapid diagnosis is mandatory for successful treatment and usually implies cardiac surgery with the correction of arterial wall. We present a case of spontaneous limited aortic dissection of the left Valsalva sinus, complicated by non-ST elevation MI (non-STEMI) presented to the emergency room as cardiogenic shock and successfully treated by emergent angioplasty of the left main, therapy which proved lifesaving as a bridge to surgery. The case highlights that even in front of a well-defined clinical, ECG and biological presentation suggestive for acute MI, one should always be mindful for the differential diagnosis of acute aortic dissection. The interventional treatment in this critical situation was effective due to the pathological peculiarity of the dissection, which was strictly focal and limited and could be stabilized by left main stenting. This case also underlines that treatment should always be adapted to the patient’s disease, and that sometimes therapies with an absolute contraindication may be a lifesaving solution in a specific context.