Acute aortic dissection debut as STEMI: A case report

We submit a case report of a 66-year-old male, with hypertension and family history of cerebrovascular disease, who was referred to our department for right-inferior STEMI.According to the current ESC (European Society of Cardiology) guidelines for the management of STEMI, the patient was conducted to the cath lab to perform primary PCI. Despite the identification of the culprit lesion we had many difficulties during the procedure of angioplasty, so we decided to perform aortography that showed a Stanford type A acute aortic dissection involving the ostium of right coronary artery causing the right-inferior STEMI.In the early phase of a STEMI, exclusion of the presence of aortic dissection using further image investigations is actually not recommended, as reported by the latest ESC STEMI guidelines.In uncommon presentation of Acute Aortic Dissection and in every case of Acute Coronary Syndrome associated with neurological symptoms and nonspecific clinical presentation, we suggest and strongly recommend the use of diagnostic algorithm proposed in the thoracic aortic disease national guidelines and a rapid echocardiographic evaluation.