Acute Type A Aortic Dissection in Patient with COVID-19 Misdiagnosed as Acute Anterior Myocardial Infarction

Authors
seyedeh samaneh tabaee
samira tabaei
Abstract
Background: Aortic dissection is a life-threatening condition with various clinical manifestations. Due to the similar clinical symptoms and risk factors, AD can be confused with acute myocardial infarction.

Case presentation: 45-year-old man presented to the hospital with severe on- and off epigastric and retrosternal discomfort, nausea, and vomiting in the preceding 48 h. He had a history of chronic untreated hypertension for more than 5 years and opium addiction in the past decade. On admission, he had normal pulses in his extremities, and his blood pressure in the right and left hands was 105/65 mmHg and 110/70, respectively. He was quickly monitored using a DC shock device. No obvious positive signs were found on physical examination. ECG showed sinus rhythm with a 2-mm ST segment elevation in the precordial leads (V3–V6). He was diagnosed with acute anterior myocardial infarction and underwent primary percutaneous coronary intervention. Contrast injection through the pigtail catheter revealed a dilated aortic root. Echocardiography and computed tomography angiography showed evidence in favor of Acute Type A Aortic Dissection. Due to the COVID-19 pandemic, the patient was examined and the PCR test result was reported to be positive. The patient underwent emergency surgery to replace the ascending aorta. Unfortunately, the patient died 6 days later.

Conclusion More case reports and long-term studies are needed to identify causal relationships between COVID-19 and dissection. It is important to consider acute aortic dissection in the differential diagnosis of acute myocardial infarction.
Keywords
Coronavirus disease 2019
Acute aortic dissection
Acute Anterior Myocardial Infarction
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