Acute Aortic Syndrome and Rheumatoid Arthritis Sı́ndrome aórtico agudo y artritis reumatoide

In this atypical case resulting in death, the first sign of the hyperadrenergic state was STEACS. Pheochromocytoma crises resembling AMI have been reported. The abnormalities were explained in terms of severe coronary vasospasm, direct myocardial damage by catecholamines, and increased oxygen uptake as a result of tachycardia and increased afterload. Characteristically, the abnormalities were transient, with normalization after treatment of the tumor. Darzé et al reported a similar case, but with no abnormal cardiospecific markers and with total recovery after treatment with a-blockers. Our case had the particular feature of clinical, laboratory, and pathological confirmation of established AMI in a patient with no obstructive lesions in her coronary arteries. The involvement of the inferior and posterior walls in the electrocardiogram, ventriculography findings, and the autopsy point to an unusually prolonged coronary vasospasm in the right coronary artery as themost probable trigger of the events experienced by the patient. Although the patient was transferred for treatment of ACS, the fatal outcome was related to massive brain and pulmonary hemorrhage, probably as a result of hypertensive crises or direct vascular damage caused by the hyperadrenergic state. In any case, administration of antiplatelet agents and anticoagulants as treatment for STEACS may have exacerbated the patient’s condition. In conclusion, the present case highlights one of the characteristics of adrenergic crises. It also points to the wide range of possible presentations that can make an accurate diagnosis so complicated in emergency situations. Santiago F. Coroleu,* Juan F. Muñoz-Camacho, Carlos Fernández-Gómez, and Xavier Tarroch-Sarasa Unidad de Hemodinámica, Hospital Universitario Mútua de Terrassa, Terrassa, Spain Unidad de Anatomı́a Patológica, Hospital Universitario Mútua de Terrassa, Terrassa, Spain