Aortic aneurysm with complete atrioventricular block and acute coronary syndrome.

BACKGROUND

Acute aortic dissection (AAD) is a highly lethal and prevalent cardiovascular emergency. AAD can develop into atrioventricular conductivity disorders caused by coronary artery dissection, with acute myocardial infarction (AMI) being the most frequent clinical sign. In many deceased patients, the diagnosis is not confirmed until autopsy, and 85 % receive the wrong therapy as a result of misdiagnosis.

METHODS

A 49-year-old male patient presenting with prolonged, intense and sharp precordial pain radiating to his back, as well as cold sweats, nausea and vomiting, was admitted to the cardiac emergency service. Thorax examination revealed normal bilateral breath sounds and a respiratory frequency of 24 incursions/min (SpO2 97 %). Cardiac auscultation revealed a heartbeat that was rhythmic, regular, and bradycardic. There was a visible high-intensity pulsation in the suprasternal notch, a diastolic murmur audible at the aortic focus, and a fourth heart sound on auscultation. The patient was diagnosed with Stanford type A AAD, concomitant complete atrioventricular block, and impairment of the right coronary artery, progressing to acute coronary syndrome (ACS) and spontaneous rupture of the aortic aneurysm. After a hemodynamic study, the patient was transferred for urgent surgical treatment and passed away during the procedure.

CONCLUSIONS

Physical examination is essential to be able to disregard AAD as the main cause of AMI. The consequences of a misdiagnosis can be fatal if thrombolytic or anticoagulant therapy is chosen as the initial treatment; therefore, surgery is the best treatment for aortic dissection.