Intracoronary Ultrasound Diagnosis of an Aortic Dissection Causing Anterior Acute Myocardial Infarction
A 63-year-old woman with a history of hypertension presented to the emergency room with the sudden onset of severe chest pain radiating to her back. The ECG (Figure 1A) showed marked ST-segment elevation in leads I, aVL, and V1-V6 and ST-segment depression in leads II, III, and aVF, suggesting acute anterior myocardial infarction. An emergency coronary angiogram demonstrated a long tight lesion of 99% stenosis (Figure 1B) in the left anterior descending coronary artery (LAD), just after the bifurcation of the left circumflex artery (LCx). Intravascular ultrasound before intervention (Figure 2) revealed a huge hematoma originating from the aorta and extending into the LAD to involve the first diagonal branch, diagnostic of type A aortic dissection. Primary angioplasty was performed successfully with implantation of 3 stents. After the procedure, the patient’s hemodynamics stabilized. She underwent repair of the aortic dissection with reconstruction of the ascending aorta.
Dr Hibi was supported by grants from the Getz-Stanford Cardiovascular Research Scholarship Program and the Uehara Memorial Foundation.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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