Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2021; 9(4): 970-975
Published online Feb 6, 2021. doi: 10.12998/wjcc.v9.i4.970
Acute inferior wall myocardial infarction induced by aortic dissection in a young adult with Marfan syndrome: A case report
Yun-Xiao Zhang, Hang Yang, Gui-Song Wang
Yun-Xiao Zhang, Gui-Song Wang, Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing 100191, China
Hang Yang, Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China
Author contributions: Zhang YX reviewed the literature and contributed to manuscript drafting; Yang H was the attending physician for the patient and contributed to manuscript drafting; Wang GS selected the figures; Wang GS was responsible for the revision of the manuscript for important intellectual content; and all authors issued final approval for the version to be submitted.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gui-Song Wang, MD, Professor, Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, No. 49 Huayuan North Road, Haidian District, Beijing 100191, China. guisongwang@bjmu.edu.cn
Received: November 10, 2020
Peer-review started: November 10, 2020
First decision: November 29, 2020
Revised: December 3, 2020
Accepted: December 11, 2020
Article in press: December 11, 2020
Published online: February 6, 2021
Processing time: 75 Days and 23.9 Hours
Abstract
BACKGROUND

Aortic dissection (AD) is an emergent and life-threatening disorder, and its in-hospital mortality was reported to be as high as 24.4%-27.4%. AD can mimic other more common disorders, especially acute myocardial infarction (AMI), in terms of both symptoms and electrocardiogram changes. Reperfusion for patients with AD may result in catastrophic outcomes. Increased awareness of AD can be helpful for early diagnosis, especially among younger patients.

CASE SUMMARY

We report a 28-year-old man with acute left side chest pain without cardiovascular risk factors. He was diagnosed with acute inferior ST-segment elevation myocardial infarction (STEMI), which, based on illness history, physical examination, and intraoperative findings, was eventually determined to be type A AD caused by Marfan syndrome. Emergent coronary angiography revealed the anomalous origin of the right coronary artery as well as eccentric stenosis of the proximal segment. Subsequently, computed tomography angiography (CTA) showed intramural thrombosis of the ascending aorta. Finally, the patient was transferred to the cardiovascular surgery department for a Bentall operation. He was discharged 13 d after the operation, and aortic CTA proved a full recovery at the 2-year follow-up.

CONCLUSION

It is essential and challenging to differentiate AD from AMI. Type A AD should be the primary consideration in younger STEMI patients without cardiovascular risk factors but with outstanding features of Marfan syndrome.

Keywords: Aortic dissection; Acute myocardial infarction; Marfan syndrome; Case report

Core Tip: We report a 28-year-old man who presented with acute chest pain and was diagnosed with acute inferior ST-segment elevation myocardial infarction that was later found to be aortic dissection (AD) induced by Marfan syndrome. Differentiating AD from acute myocardial infarction (AMI) remains difficult. Suspicion of Marfan syndrome in young patients without risk factors for atherosclerosis increases the likelihood of AD over AMI. Difficulty in engaging the coronary artery or the presence of proximal eccentric stenosis is suggestive of type A AD.