动脉瘤患者出现 STEV 心肌梗死:多模态成像在急诊中的作用--病例报告

{"title":"动脉瘤患者出现 STEV 心肌梗死:多模态成像在急诊中的作用--病例报告","authors":"","doi":"10.1007/s42399-024-01646-w","DOIUrl":null,"url":null,"abstract":"<h3>Abstract</h3> <p>Aortic dissection with concurrent ST-elevation myocardial infarction (STEMI) is rarely reported. As the proportion of myocardial infarction is higher in the emergency setting compared to aortic dissection, the diagnosis of aortic dissection may be overlooked, and it can be potentially fatal. By using bedside available information, detailed history taking, and multimodality imaging in the emergency setting, it is possible to avoid a mistaken diagnosis. Here, we present a case of aortic aneurysm presenting with anterior STEMI. A 79-year-old woman was admitted to our emergency department with decreased consciousness. Shortly before the patient went unconscious, she had a short episode of dyspnea. Her ECG showed marked ST elevation in the anterior leads. However, her chest radiograph revealed mediastinal widening and a prominent aortic knob. Due to suspicion of aortic dissection from the chest radiograph and loss of consciousness, which may be a sign of malperfusion syndrome of aortic dissection, bedside handheld echocardiography was then performed. It revealed hypokinesis of anterior and anteroseptal walls, pericardial effusion, and dilated aortic root to ascending aorta with severe aortic regurgitation. The presence intimal flap can not be clearly excluded. Based on her imaging and clinical findings, aortic dissection was suspected and thrombolysis was postponed. The patient proceeded to undergo triple-rule-out computed tomography, from which the finding of ascending aortic aneurysm was noted, along with multiple stenosis of LAD (moderate-to-severe) and LCx (moderate), and there was no presence of false lumen. Acute aortic dissection should be considered a differential diagnosis in patients presenting with symptoms suggesting acute coronary syndrome. A suspected case of acute aortic dissection should necessitate further imaging studies. Therefore, multimodality imaging plays a vital role in the emergency setting, as it may avoid fatal consequences of misdiagnosis and mistreatment.</p>","PeriodicalId":21944,"journal":{"name":"SN Comprehensive Clinical Medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Aneurysmatic Patient Presenting with ST-Elevation Myocardial Infarction: Role of Multimodality Imaging in Emergency Setting—A Case Report\",\"authors\":\"\",\"doi\":\"10.1007/s42399-024-01646-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3>Abstract</h3> <p>Aortic dissection with concurrent ST-elevation myocardial infarction (STEMI) is rarely reported. As the proportion of myocardial infarction is higher in the emergency setting compared to aortic dissection, the diagnosis of aortic dissection may be overlooked, and it can be potentially fatal. By using bedside available information, detailed history taking, and multimodality imaging in the emergency setting, it is possible to avoid a mistaken diagnosis. Here, we present a case of aortic aneurysm presenting with anterior STEMI. A 79-year-old woman was admitted to our emergency department with decreased consciousness. Shortly before the patient went unconscious, she had a short episode of dyspnea. Her ECG showed marked ST elevation in the anterior leads. However, her chest radiograph revealed mediastinal widening and a prominent aortic knob. Due to suspicion of aortic dissection from the chest radiograph and loss of consciousness, which may be a sign of malperfusion syndrome of aortic dissection, bedside handheld echocardiography was then performed. It revealed hypokinesis of anterior and anteroseptal walls, pericardial effusion, and dilated aortic root to ascending aorta with severe aortic regurgitation. The presence intimal flap can not be clearly excluded. Based on her imaging and clinical findings, aortic dissection was suspected and thrombolysis was postponed. The patient proceeded to undergo triple-rule-out computed tomography, from which the finding of ascending aortic aneurysm was noted, along with multiple stenosis of LAD (moderate-to-severe) and LCx (moderate), and there was no presence of false lumen. Acute aortic dissection should be considered a differential diagnosis in patients presenting with symptoms suggesting acute coronary syndrome. A suspected case of acute aortic dissection should necessitate further imaging studies. Therefore, multimodality imaging plays a vital role in the emergency setting, as it may avoid fatal consequences of misdiagnosis and mistreatment.</p>\",\"PeriodicalId\":21944,\"journal\":{\"name\":\"SN Comprehensive Clinical Medicine\",\"volume\":\"7 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-01-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"SN Comprehensive Clinical Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s42399-024-01646-w\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"SN Comprehensive Clinical Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s42399-024-01646-w","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

摘要 主动脉夹层并发 STEMI(ST 段抬高型心肌梗死)的报道很少。与主动脉夹层相比,心肌梗死在急诊中的比例更高,因此主动脉夹层的诊断可能会被忽视,而且有可能致命。在急诊环境中,通过床旁可用信息、详细病史采集和多模态成像,可以避免误诊。在此,我们介绍一例主动脉瘤并发前部 STEMI 的病例。急诊科收治了一名意识减退的 79 岁女性患者。在患者昏迷前不久,她出现了短暂的呼吸困难。她的心电图显示前导联ST段明显抬高。然而,她的胸片却显示纵隔增宽,主动脉旋钮突出。由于从胸片和意识丧失中怀疑是主动脉夹层,而意识丧失可能是主动脉夹层灌注不良综合征的征兆,于是对她进行了床旁手持超声心动图检查。随后进行了床旁手持式超声心动图检查,结果显示主动脉前壁和前隔壁运动减弱,心包积液,主动脉根部至升主动脉扩张,伴有严重的主动脉瓣反流。无法明确排除内膜瓣的存在。根据她的影像学和临床检查结果,医生怀疑是主动脉夹层,并推迟了溶栓治疗。患者接着接受了三重排除计算机断层扫描,结果发现了升主动脉瘤,以及 LAD(中度至重度)和 LCx(中度)的多发性狭窄,并且没有发现假腔。对于出现急性冠状动脉综合征症状的患者,急性主动脉夹层应被视为鉴别诊断之一。急性主动脉夹层的疑似病例应进行进一步的影像学检查。因此,多模式成像在急诊环境中起着至关重要的作用,因为它可以避免误诊和误治造成的致命后果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Aneurysmatic Patient Presenting with ST-Elevation Myocardial Infarction: Role of Multimodality Imaging in Emergency Setting—A Case Report

Abstract

Aortic dissection with concurrent ST-elevation myocardial infarction (STEMI) is rarely reported. As the proportion of myocardial infarction is higher in the emergency setting compared to aortic dissection, the diagnosis of aortic dissection may be overlooked, and it can be potentially fatal. By using bedside available information, detailed history taking, and multimodality imaging in the emergency setting, it is possible to avoid a mistaken diagnosis. Here, we present a case of aortic aneurysm presenting with anterior STEMI. A 79-year-old woman was admitted to our emergency department with decreased consciousness. Shortly before the patient went unconscious, she had a short episode of dyspnea. Her ECG showed marked ST elevation in the anterior leads. However, her chest radiograph revealed mediastinal widening and a prominent aortic knob. Due to suspicion of aortic dissection from the chest radiograph and loss of consciousness, which may be a sign of malperfusion syndrome of aortic dissection, bedside handheld echocardiography was then performed. It revealed hypokinesis of anterior and anteroseptal walls, pericardial effusion, and dilated aortic root to ascending aorta with severe aortic regurgitation. The presence intimal flap can not be clearly excluded. Based on her imaging and clinical findings, aortic dissection was suspected and thrombolysis was postponed. The patient proceeded to undergo triple-rule-out computed tomography, from which the finding of ascending aortic aneurysm was noted, along with multiple stenosis of LAD (moderate-to-severe) and LCx (moderate), and there was no presence of false lumen. Acute aortic dissection should be considered a differential diagnosis in patients presenting with symptoms suggesting acute coronary syndrome. A suspected case of acute aortic dissection should necessitate further imaging studies. Therefore, multimodality imaging plays a vital role in the emergency setting, as it may avoid fatal consequences of misdiagnosis and mistreatment.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Evaluation of Dyspnea, Physical Activity, Muscle Strength, and Quality of Life in Frail Older Adults with COPD Sonographic Changes in Median Nerve Diameter in Pregnant Women: An Indicator of Carpel Tunnel Syndrome Primary Health Care Workers Turnover intention and Organizational behavior: Systematic Review and Meta-analysis Ventilation/Perfusion Mismatch in a Child Following Cocaine Ingestion: Case Report Clinical Course of a Patient with Alpha-Heavy Chain Deposition Disease (a Case Report)
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1