AD symptoms may be similar to those of other heart disorders; AD is frequently confused with myocardial ischemia leading to a delayed or misdiagnosis, resulting in inappropriate treatment, including antithrombotic agents. (2)
When a dissection flap extends proximally, it may impinge on the orifice of one of the coronary arteries resulting in acute myocardial infarction (AMI) or ischemia. The dissection channel frequently propagates along the greater curvature of the Aorta and may compromise the Ostia of the arch vessels. Given its location on the greater curvature, the right coronary artery is particularly vulnerable to occlusion. This fact helps explain why most myocardial infarctions complicating aortic dissection are inferior in location. However, for patients with AMI, the missed diagnosis of AD could be catastrophic because the antiplatelet therapy and the cardiac catheterization, which are the therapeutic approaches for AMI, are exactly two absolute contraindications to AD treatment, as both of them can aggravate bleeding, broaden the range of the dissection, and even increase the risk of death. (3, 4)
The pain in approximately 17% of cases can change location and follow the dissection path. And other signs like Loss of consciousness, Shortness of breath, Sudden difficulty speaking, loss of vision, weakness or paralysis of one side of your body, similar to those of a stroke, Weak pulse in one arm or thigh compared with the other, leg pain, difficulty walking, leg paralysis, nausea and vomiting. (5)
Standard tests used to diagnose aortic incision include a chest iodine CT scan and an echocardiogram (sensitivity of 77–80% and a specificity of 93–96%(. Both Transthoracic Echocardiography (TTE) and Transesophageal Echocardiography (TEE) can be performed quickly for the hemodynamically unstable patient. The TEE can identify the entry site of dissection, the presence of false lumen thrombus, an undulating intimal flap that differentiates the false lumen from the true lumen, the involvement of arch and coronary vessels, pericardial effusion, and severity of aortic valve regurgitation. Other tests that may be used include an aortogram or angiogram of the aortic magnetic resonance or a higher frequency ultrasound. Measurement of blood D-dimer level may be helpful in diagnostic evaluation. Each of these tests has pros and cons and does not have the same sensitivity and characteristics in diagnosing aortic dissection. (6)
10% of type B dissection patients have electrocardiographic signs of ischemia. So differential diagnosis should be performed on all patients to differentiate pain from AMI and AD. A normal ECG was seen in one-third of patients. ECG showed non-specific ST-and T-wave changes in 42%, ischemic changes in 15%, and evidence of acute myocardial infarction in 5% of patients with an ascending aortic dissection. (7)
The chest x-ray is insufficient to rule out or diagnose aortic dissection; however, it has been reported abnormal in 60%-90% of patients. (8)
Both AD and AMI may have onset with acute chest pain, and it is sometimes difficult to diagnose them by symptoms, ECG changes, and/or cardiac biomarkers.
Our case was presented with ECG changes in ST-elevation and VF, which was similar to anterior MI. the physician did echocardiography to confirm his diagnosis and noticed aortic dissection, according to the witness. In contrast, for aortic dissection, we expect inferior MI to occur.