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J Korean Soc Emerg Med > Volume 27(1); 2016 > Article
Journal of The Korean Society of Emergency Medicine 2016;27(1): 30-35.
초기에 ST분절 상승 심근경색증으로 발현된 대동맥 박리환자들의 임상양상
이민지, 박영선, 안신, 손창환, 서동우, 이재호, 이윤선, 임경수, 김원영
울산대학교 의과대학 서울아산병원 응급의학교실
Clinical Features of Acute Aortic Dissection Patients Initially Diagnosed with ST-segment Elevation Myocardial Infarction
Min Jee Lee, Young Sun Park, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Jae Ho Lee, Yoon Seon Lee, Kyung Soo Lim, Won Young Kim
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea
Correspondence  Won Young Kim ,Tel: 02) 3010-3350, Fax: 02) 3010-3360, Email: wonpia73@naver.com,
Received: July 15, 2015; Revised: July 16, 2015   Accepted: October 11, 2015.  Published online: February 29, 2016.
Acute myocardial infarction (AMI) concomitant with acute aortic syndrome (AAS) is rare but prompt recognition of concomitant AAS is critical, particularly in patients with ST-segment elevation myocardial infarction (STEMI) because misdiagnosis with early thrombolytic or anticoagulant treatment may result in catastrophic consequences. This study examined the clinical features of patients of STEMI concomitant with AAS that may be a diagnostic clue.
Between January 1, 2010 and December 31, 2014, 22 patients who had the initial diagnosis of acute coronary syndrome (AMI and unstable angina) and AAS (aortic dissection, intramural hematoma, and ruptured thoracic aneurysm) in our emergency department were reviewed. Among them, 10 patients who were transferred from other hospitals and 4 patients with non-STEMI were excluded, leaving 8 patients of STEMI concomitant with AAS for analysis.
The mean age of study patients was 57.5±16.31 years and five patients were Stanford type A and three patients were type B aortic dissection. Six patients had ST-segment elevation in anterior leads and 2 patients in inferior leads. Most patients had acute onset and severe chest pain, but none had dissecting nature chest pain. Serum troponin I was elevated in three patients but all patients had D-dimer elevation. Aortic regurgitation or regional wall motion abnormality was detected in four patients, and widened mediastinum was observed in all study patients.
Concomitant AAS might be suspected in patients with STEMI who have elevated D-dimer and widened mediastinum.
Key words: Aortic dissection, D-dimer, Myocardial infarction, ST-segment
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