Acute chest pain of cardiovascular aetiology: A diagnostic dilemma

摘要

A 61-year-old gentleman was admitted to his local hospital with a 5-h history of central chest pain. He was an ex-smoker with no other cardiac risk factors or history of ischaemic heart disease. ECG on presentation demonstrated ST elevation in leads 1 and aVL consistent with acute myocardial infarction (Ml) and he was therefore thrombolysed with tenecte-plase. Following thrombolysis, his ST segment elevation resolved and his chest pain subsided completely. Peak CK was 1015U/I (24-173U/I) and troponin T 3.65 ug/l (0-0.10ug/I). A routine PA chest radiograph revealed a widened superior mediastinum, raising the possibility of aortic dissection (Figure 1). An urgent contrast enhanced CT scan was therefore requested which demonstrated a type A aortic dissection with an aneurysmal ascending aorta (Figure 2).