Aortic dissection electrocardiogram

Aortic dissection Microchapters
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Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]

Overview

ST elevation myocardial infarction (MI) due to occlusion by the dissection of the coronary artery at its ostium may be present. The right coronary artery tends to be involved more frequently than the left coronary artery. Electrical alternans may be present in the setting of a pericardial effusion should the dissection have extended into the pericardium.

Electrocardiogram

EKG findings in aortic dissection are usually non-specific. Possible findings include:

• Sinus tachycardia
• Acute ST segment elevation may be seen in 1% - 2% of the patients, signifying the occurrence of STEMI due to involvement of coronary arteries by the dissection
• In the setting of dissection involving the pericardium causing pericardial effusion, an electrical alterans may be present

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guideline Recommendations: Evaluation and Management of Acute Thoracic Aortic Disease (DO NOT EDIT)

Screening Tests (DO NOT EDIT)

Class I

"1. An electrocardiogram should be obtained on all patients who present with symptoms that may represent acute thoracic aortic dissection."

"a. Given the relative infrequency of dissection-related coronary artery occlusion, the presence of ST-segment elevation suggestive of myocardial infarction should be treated as a primary cardiac event without delay for definitive aortic imaging unless the patient is at high risk for aortic dissection. (Level of Evidence: B)"