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BackgroundDouble aortic arch (DAA) with type B aortic dissection in adults is a rare aortic vascular disease. Computed tomography angiography (CTA) indicated a double aortic arch anomaly with localized dissection of the descending aorta.
This is another case written by Pendell Meyers (who is helping to edit the blog and has many great recent posts) Case A 45 year old man was driving to work when he experienced acute onset sharp left sided chestpain with paresthesias of the left arm. A repeat ECG was recorded with pain 2/10: Not much change.
A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chestpain, shortness of breath, and diaphoresis after consuming a large meal at noon. He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic.
A middle aged male presented at midnight after 14 hours of constant, severe substernal chestpain, radiating to his throat and to bilateral jaws, and associated with diaphoresis. The pain was not positional, pleuritic, or reproducible. It was not relieved by anything. He had no previous medical history.
An elderly woman presented with chestpain that radiated to the back for several hours. The first troponin returned at 0.099 ng/mL (elevated, consistent with Non-Occlusion MI) Providers were concerned with aortic dissection, so they order a chest aorta CT. It is essentially normal.
The provider had sent the patient for an aortic dissection scan which had shown extremely heavy calcification of the LAD. The patient had continued to have chestpain. There was a 100% proximal LAD occlusion that was opened and stented. The cath lab was activated. But 45 minutes later than it should have been.
Previous medical interventions included a spectrum of procedures, including catheter-directed thrombectomy for popliteal artery aneurysms with thrombosis, vascular bypass grafting for cerebral-anterior communicating artery aneurysms and arch replacement and stent implantation for aortic dissecting aneurysms.
Description of Case:A 64-year-old male with complex medical history, including infective endocarditis of the aortic valve requiring surgical replacement with a bioprosthetic valve and recurrent infective endocarditis of the bioprosthetic valve, presented with two hours of crushing chestpain and found to have ST elevations.
A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chestpain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go.
60-something with h/o MI and stents presented with chestpain radiating to the back and nausea/vomiting. There was concern for aortic dissection, so a CT was done and was negative. It was stented. The patient had a p rior h istory of MI + stents. Time zero What do you think? There is inferior ST elevation.
This fantastic case and post was written by Jesse McLaren (@ECGcases), edited by Smith Case You’re shown an ECG from a patient in the waiting room with chestpain. It was a 60yo with a history of stents to the circumflex and right coronary arteries, who presented with 9 hours of fluctuating central chestpain.
There is ventricular hypertrophy in the absence of abnormal loading conditions, such as aortic stenosis, or hypertension, for example – of which the most common variant is Asymmetric Septal Hypertrophy. A mid-LAD culprit lesion was identified and stented. Below are two examples of this.
As his pain was very severe, emergency physicians concerned of aortic dissection and ordered a thoracic CT scan. The lesion was successfully stented. The pain was completely resolved after coronary intervention. Bi-phasic scan showed no dissection or pulmonary embolism. Aspirated thrombotic material.
A middle-aged male with h/o CAD and stents presented with typical chest pressure. An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." Case 3 : Male in 30's with chestpain, cough, and fever.
His comments/questions are inserted below the ECG: A 50-something woman presented with 3 days of intermittent chestpain that became worse on the day of presentation, with diaphoresis and radiation to the left arm, as well as abdominal pain. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease.
All of the patients contacted EMS due to acute onset chestpain. The above ECG is from a 70 something male with chestpain. ECG #2 Case 2 : The above ECG was obtained from a diabetic 45 year old smoker with chestpain. Following the improvement in the ECG the patient's pain too improved drastically.
Written by Hans Helseth A 34 year old man with no known medical history presented to the ED after an hour of chestpain. He described the pain as a mid sternal "burning sensation" and rated it 8.5 out of 10 at onset, but on presentation to the ED, reported that the pain had improved to 4.5. 10 chestpain.
Type B aortic dissection (TBAD) during pregnancy is a rare disease, which is mostly caused by the increase of blood volume in circulation during pregnancy, the effect of estrogen and progesterone on the aorta, or congenital diseases. Thoracoabdominal aortic computed tomography with angiography (CTA) showed acute TBAD.
There was some question of whether the patient was having abdominal pathology, and she also had a history of aortic pathology, so a chest abd/pelvic with aorta angiogram was ordered. It was opened and stented. If this were ACUTE (vs. SUBACUTE) OMI, that would result in an undesirable delay. How do I know?
This was submitted by a paramedic, Hailey Kennedy A late 50s male called 911 following 2 hours of chestpain that started while working at his desk. He reported the crushing chestpain radiated down his left arm. He presented to the ED for evaluation chestpain. Pain was improved but not gone upon arrival.
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