PMID: 9556871Apr 29, 1998Paper

Lysis therapy in aortic dissection: by hypertrophic cardiomyopathy simulated myocardial infarct

Zeitschrift für Kardiologie
Y KodolitschC A Nienaber

Abstract

A 52-year-old patient presenting with severe thoracic pain of more than 30 minutes duration and ST-segment elevation > 1 mV in leads V1-3 was given 100 mg rt-PA. With persisting thoracic pain and ST-segment elevation, coronary angiography was performed 90 minutes after administration of thrombolytic therapy. Surprisingly, angiography revealed normal coronary arteries in presence of marked hypertrophic cardiomyopathy. New onset of thoracic pain after four hours led to a chest radiograph demonstrating increased mediastinal widening and new pleural effusion as compared to a baseline chest film prior to rt-PA. Spiral computed tomography revealed overt Type B aortic dissection with an intimal flap and communication distal to the origin of the left subclavian artery with signs of a mediastinal hematoma. Immediate cardiac surgery with replacement of the dissected aortic segment was successfully performed. A literature review revealed 4% of aortic dissection to present with electrocardiographic signs of acute myocardial infarction and 13% to have concomitant coronary artery disease; moreover 34 cases of aortic dissection were misdiagnosed as infarction and subjected to thrombolytic agents with a mortality of 64% underlining the importa...Continue Reading

Citations

Jan 18, 2011·Medizinische Klinik·Stefanie JänischDetlef Günther
Jul 25, 2009·Deutsches Ärzteblatt International·Mine Arslan-KirchnerJörg Schmidtke

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