Acute myocardial infarction caused by acute ascending aortic dissection

Acute myocardial infarction (AMI) secondary to acute ascending aortic dissection is a rare condition. The clinical presentations are similar but treatment strategies are different between AMI due to thrombotic occlusion of coronary arteries and that secondary to aortic dissection. In the latter, emergency surgery is the first choice and thrombolytic therapy is absolutely contraindicated. We report a 44-year-old man, who suddenly developed acute anterior chest pain. The diagnosis at emergency room was inferior wall AMI and the patient was treated with thrombolysis followed by coronary intervention. However, aortic dissection was suspected during cardiac catheterization and then comfirmed by echocardiography. The patient underwent emergent cardiac surgery to repair the aortic wall and bypass the proximal portion of right coronary artery (RCA). The follow-up coronary angiogram 3 months later showed patent RCA. From this case, we learn that in patients with an AMI, the possibility of aortic dissection should be kept in mind. If there is any suspicion, echocardiography can serve as a safe and quick tool to detect the possibility.