Aortic Dissection or MI? It could be both

Acute aortic dissection is a potentially lethal vascular emergency that involves the rapid development of a false blood channel within the media of the aorta. If left untreated, approximately 50% of patients die in the first 48 hours, and the mortality rate increases by 1% to 3% per hour [1,2]. Despite recent advances in diagnostic methods, misdiagnosis occurs in 25%-50% of patients on initial evaluation with symptoms mimicking those of acute myocardial infarction and other cardiovascular disorders [3-5]. To further complicate an accurate diagnosis, ascending aortic dissections may involve the coronary and carotid arteries, resulting in myocardial infarction and stroke. With prompt diagnosis and treatment, one-year survival has been steadily improving and has been reported as high as 90% [6]. Therefore, timely diagnosis and rapid management of this disorder is imperative in the prehospital setting and in the Emergency Department. It is crucial that paramedics, emergency physicians and nurses maintain appropriate clinical suspicion for aortic dissection in patients presenting with sudden chest, back, or abdominal pain and asymmetrical pulses and blood pressures.