Answer: Uncommon masquerader of inferior STEMI

Answer document

Correct answer: 2. Aortic Dissection

JR-4 guide into aortic root with non-selective shot suggest aortic dissection—filling the right coronary artery therefore in the false lumen (see Supplementary material online, Video S1 and Figure 1B, arrow indicates right coronary artery). Acute Type A aortic dissection is then confirmed with pigtail aortogram where the true lumen is shown and filling the left main artery (see Supplementary material online, Video S2 and Figure 1C, arrow indicates dissection flap). Glyceryl trinitrate infusion was started with gradual titration for his hypertension. Patient was transferred to a cardiothoracic centre but unfortunately arrested on the computed tomography table before he could be operated.

Figure 1

(A) is the patient's 12- lead electrocardiogram. (B) is the JR-4 guided luminogram of the aortic root. (C) is the pigtail aortogram.

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Myocardial infarction resulted from functional coronary artery occlusion where the dissection flap occluded the ostium of right coronary artery in this case. Invasive aortography remains a valuable tool for rapid and accurate diagnosis of aortic dissection particularly in patients presenting with ST-elevation myocardial infarction.

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