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Aortic dissection presenting as syncope with an inferior STEMI
Visual Journal of Emergency Medicine 6 (2017) 31–32
Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
Aortic dissection presenting as syncope with an inferior STEMI a,⁎
Andrew Frei, MD , Robert Stuntz, MD FACEP a b
b
crossmark
PGY2 EM Resident, Wellspan York Hospital Emergency Medicine Residency, York, PA 17403, USA Program Director, Wellspan York Hospital Emergency Medicine Residency, York, PA 17403, USA
A R T I C L E I N F O Keywords: Syncope Aortic Dissection Coronary Artery Dissection ST-Elevation Myocardial Infarction (STEMI)
A 69 yo female presented to the ED for syncope. Prior to this episode, she had been in her usual state of health. She was on lisinopril for hypertension, and family indicated she had an unknown outpatient procedure upcoming. Prior to arrival, her family heard a thud and found her on the floor. Her only complaint on arrival was feeling “unwell.” She was diaphoretic with a fluctuating LOC. Abnormal vitals included a BP of 101/42 and a RR of 22. An EKG revealed inferior ST
elevation with lateral reciprocal changes (Fig 1). Her labs showed a lactic acid of 3.1 and troponin of 0.05. A point of care echo revealed a Type A aortic dissection, likely extending into the right coronary artery, as well as a AAA with a dissection flap (Video 1, Fig 2). Cardiology and CT surgery were consulted. A comprehensive bedside TTE confirmed the diagnosis, and the patient was taken emergently to the OR with CT surgery.
Fig. 1. EKG obtained in ED showing inferior ST elevation with lateral reciprocal changes.
⁎
Corresponding author.
http://dx.doi.org/10.1016/j.visj.2016.07.002 Received 24 May 2016; Accepted 7 July 2016 2405-4690/ © 2016 Elsevier Inc. All rights reserved.
Visual Journal of Emergency Medicine 6 (2017) 31–32
A. Frei, R. Stuntz
Supplementary material related to this article can be found online at doi:10.1016/j.visj.2016.07.002. Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at doi:10.1016/j.visj.2016.07.002.
Fig. 2. Bedside ED US still image demonstrating AAA with dissection flap.
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Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
Aortic dissection presenting as syncope with an inferior STEMI a,⁎
Andrew Frei, MD , Robert Stuntz, MD FACEP a b
b
crossmark
PGY2 EM Resident, Wellspan York Hospital Emergency Medicine Residency, York, PA 17403, USA Program Director, Wellspan York Hospital Emergency Medicine Residency, York, PA 17403, USA
A R T I C L E I N F O Keywords: Syncope Aortic Dissection Coronary Artery Dissection ST-Elevation Myocardial Infarction (STEMI)
A 69 yo female presented to the ED for syncope. Prior to this episode, she had been in her usual state of health. She was on lisinopril for hypertension, and family indicated she had an unknown outpatient procedure upcoming. Prior to arrival, her family heard a thud and found her on the floor. Her only complaint on arrival was feeling “unwell.” She was diaphoretic with a fluctuating LOC. Abnormal vitals included a BP of 101/42 and a RR of 22. An EKG revealed inferior ST
elevation with lateral reciprocal changes (Fig 1). Her labs showed a lactic acid of 3.1 and troponin of 0.05. A point of care echo revealed a Type A aortic dissection, likely extending into the right coronary artery, as well as a AAA with a dissection flap (Video 1, Fig 2). Cardiology and CT surgery were consulted. A comprehensive bedside TTE confirmed the diagnosis, and the patient was taken emergently to the OR with CT surgery.
Fig. 1. EKG obtained in ED showing inferior ST elevation with lateral reciprocal changes.
⁎
Corresponding author.
http://dx.doi.org/10.1016/j.visj.2016.07.002 Received 24 May 2016; Accepted 7 July 2016 2405-4690/ © 2016 Elsevier Inc. All rights reserved.
Visual Journal of Emergency Medicine 6 (2017) 31–32
A. Frei, R. Stuntz
Supplementary material related to this article can be found online at doi:10.1016/j.visj.2016.07.002. Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at doi:10.1016/j.visj.2016.07.002.
Fig. 2. Bedside ED US still image demonstrating AAA with dissection flap.
32