ABSTRACT
Introduction: Atherosclerotic coronary artery thrombosis is the most common cause of acute myocardial infarction. Clinical Picture: A 30-year-old lady presented with acute peripartum massive anterior ST segment myocardial infarction and cardiogenic shock. This was due to acute Stanford type A aortic dissection with the intimal flap occluding the left coronary ostium. The initial diagnosis was not apparent. Echocardiography confirmed the diagnosis. Treatment and Outcome: She underwent emergency surgical repair (Bentall procedure). Pathology confirmed underlying idiopathic cystic medial degeneration. Conclusion: A high index of clinical suspicion is required in acute myocardial infarction presenting without traditional cardiovascular risk factors.
Reperfusion therapy in the form of primary angioplasty or thrombolytic therapy is the cornerstone of management in patients presenting with acute ST segment elevation myocardial infarction (STEMI).1 Thrombosis of the atherosclerotic coronary artery is by far the most common cause of acute myocardial infarction. In patients without traditional risk factors, other possible uncommon aetiologies need to be considered. In many medical centres where thrombolytic therapy is the first-line reperfusion therapy for acute STEMI, the outcome may be catastrophic in clinical situations such as acute aortic dissection. This case report stresses the importance of a high index of suspicion of non-atherosclerotic causes such as aortic dissection as a possible cause of acute STEMI. In addition, we discuss the need to be selective in performing coronary angiography in patients with acute aortic dissection, in order to improve clinical outcome.
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