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https://doi.org/10.15836/ccar2023.183

Acute ST-segment elevation myocardial infarction and ischemic stroke in a 45-year-old female patient

Tea Domjanović Škopinić orcid id orcid.org/0000-0002-4989-6974 ; University Hospital of Split, Split, Croatia
Andrija Matetić orcid id orcid.org/0000-0001-9272-6906 ; University Hospital of Split, Split, Croatia
Anja Mandrapa orcid id orcid.org/0009-0002-3416-5906 ; University Hospital of Split, Split, Croatia
Paula Radić orcid id orcid.org/0000-0002-7273-6696 ; University Hospital of Split, Split, Croatia
Ivona Mustapić orcid id orcid.org/0000-0002-1534-3642 ; University Hospital of Split, Split, Croatia
Darija Baković Kramarić orcid id orcid.org/0000-0001-6751-5242 ; University Hospital of Split, Split, Croatia


Puni tekst: engleski pdf 197 Kb

str. 183-183

preuzimanja: 191

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Sažetak

Ključne riječi

imaging in aortic disease; aortic thrombosis, antiphospholipid syndrome

Hrčak ID:

302818

URI

https://hrcak.srce.hr/302818

Datum izdavanja:

27.4.2023.

Posjeta: 492 *



Introduction: The most important imaging modality in diseases of the aorta is multi-slice computed tomography (MSCT) angiography. However, echocardiography can often help distinguish acute aortic syndrome from other causes of chest pain (1,2). Here, we present a case of a 45-year-old female patient who was admitted to the emergency department (ED) with acute ST-segment elevation myocardial infarction and neurological deficit in form of left-sided hemiparesis.

Case report: 45-year-old female patient with no previous medical history presented to the ED with chest pain that lasted for 2-3 hours before the ED visit. 12-lead electrocardiogram revealed ST-segment elevation in inferior and lateral leads. During the physical examination, it was also noted that she had left-sided hemiparesis and facial paresis. Point-of-care echocardiography was performed where the wall of the available descending part of the aorta could not be clearly visualized. This directed further diagnostic process to MSCT of the brain which showed no ischemic zones and MSCT aortography where multiple thrombi were visualized at the brachiocephalic trunk origin, aortic arch, and the descending aorta (Figure 1A). Furthermore, perfusion defects were verified in the right kidney. Due to the high risk of thrombotic masses dissemination, invasive coronary angiography was not performed. Instead, alteplase was administered (0.9 mg/kg). Complete neurological recovery and ST-segment elevation resolution were achieved. Her blood workup showed mildly elevated levels of high sensitive troponin T (61.8 ng/L), N-terminal pro-BNP (335 pg/mL), and very high levels of D-dimer (>35.2 mg/L). Echocardiography revealed hypokinesis of the inferior and posterior wall with preserved systolic and diastolic function of the left ventricle. Control aortography showed regression in the size of aortic thrombi (Figure 1B) and kidney perfusion defects. Extended laboratory work-up revealed mildly elevated levels of anticardiolipin antibodies and β2-glycoprotein (both class IgM). Since the patient was a foreign citizen, she was transported to her country to continue further medical evaluation.

FIGURE 1 A. Initial MSCT of the aorta showing multiple thrombi. B. Control MSCT of the aorta 1 day after thrombolysis showing significant regression in sizes of thrombi.
CC202318_5-6_183-f1

Conclusion: Echocardiography can be a valuable tool in directing the diagnostic process for diseases of the aorta. This points to the importance of point-of-care ultrasonography availability in the ED, as it speeds up the process of establishing the final diagnosis.

LITERATURE

1 

Nazerian P, Mueller C, Vanni S, Soeiro A de M, Leidel BA, Cerini G, et al. Integration of transthoracic focused cardiac ultrasound in the diagnostic algorithm for suspected acute aortic syndromes. Eur Heart J. 2019 June 21;40(24):1952–60. https://doi.org/10.1093/eurheartj/ehz207 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/31226214

2 

Goldstein SA, Evangelista A, Abbara S, Arai A, Asch FM, Badano LP, et al. Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 February;28(2):119–82. https://doi.org/10.1016/j.echo.2014.11.015 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/25623219


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