Question: Uncommon masquerader of inferior STEMI

Figure 1

(A) Patient's 12-lead electrocardiograph. (B) JR-4 guided aortography with non-selective shot. (C) Pigtail aortography.

Open in new tabDownload slide

Question document

A 54-year-old man brought into the emergency department with acute onset of chest pain. He had background history of hypertension. Physical examination was notable for an elevated blood pressure of 165/85 mmHg. His chest was clear to auscultation and his heart sound did not reveal any murmur. His electrocardiograph showed inferior ST Elevation Myocardial Infarction (STEMI) as shown in Figure 1A.

Patient was transferred urgently to the catheterization laboratory for coronary angiography. Ultrasound guided vascular access was obtained in the right femoral artery. JL-4 catheter was used but noted to be catching in the ascending aorta. JR-4 guide into aortic root with non-selective shot is shown in Figure 1B (see Supplementary material online, Video S1). A pigtail aortogram was performed as shown in Figure 1C (see Supplementary material online, Video S2).

What is your diagnosis?

1. Dilated aortic root

2. Acute aortic dissection

3. Aortic valve thrombus

4. Right coronary artery occlusion

Supplementary material

Supplementary material is available at European Heart Journal: Acute Cardiovascular Care online.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The data underlying this article are available in the article and in its online supplementary material.

Author notes