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Aortic dissection presenting as concomitant stroke and STEMI

Journal of Human Hypertension volume 21, pages 818–821 (2007)Cite this article

Aortic dissection is a disease of immediate consequence, as mortality of a proximal dissection is in excess of 50% when left untreated. Early recognition of the dissection event can lead to faster definitive correction with surgical and/or novel percutaneous approaches. Widely varying signs and symptoms can, however, make this diagnosis a challenge, further complicated by the fact that no specific imaging modality is ideal, nor immediately available, in all cases. Care must be taken in patients where methodical evaluation is difficult, including physical exam, standard electrocardiogram and chest X-ray, before more definitive imaging. This is a case of aortic dissection that is presented as concomitant ST elevation myocardial infarction and embolic stroke, in which the patient received thrombolytics before diagnosis of the dissection itself. This arguably may have worsened her clinical course.

The patient is a 55-year-old woman with a history of tobacco use, hypertension and hyperlipidemia. She was at a family banquet and had mentioned that, over the course of the morning, she had experienced ‘queasiness.’ Per family members who witnessed the events to follow, she abruptly reached to her upper chest and neck, indicating discomfort, before slumping into her chair. She subsequently began to exhibit seizure activity, including incontinence of stool and urine. Paramedics arrived on the scene to find her in her chair with head extended, blood pressure at 110/42, pulse at 56.

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Authors and Affiliations

  1. Department of Internal Medicine at University of Wisconsin, Madison, WI, USA

    J Cook

  2. Department of Heart and Vascular Noninvasive Testing at University of Wisconsin, Madison, WI, USA

    S Aeschlimann

  3. Department of Cardiology, University of Wisconsin, Madison, WI, USA

    A Fuh & S M Chang

  4. Department of Cardiothoracic Surgery, University of Wisconsin, Madison, WI, USA

    T Kohmoto

Authors
  1. J Cook
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  2. S Aeschlimann
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  3. A Fuh
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  4. T Kohmoto
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  5. S M Chang
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Correspondence to J Cook.

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Cook, J., Aeschlimann, S., Fuh, A. et al. Aortic dissection presenting as concomitant stroke and STEMI. J Hum Hypertens 21, 818–821 (2007). https://doi.org/10.1038/sj.jhh.1002208

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