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Suspected ST segment elevation myocardial infarction referred for primary angioplasty: a masquerader
  1. Abhivrath Yennu Nandan1,
  2. Abhinav Singh2,
  3. Navin Mukundu Nagesh1 and
  4. Manish M Gandhi1
  1. 1 Cardiology Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
  2. 2 King’s College NHS Foundation Trust, Princess Royal University Hospital, Orpington, UK
  1. Correspondence to Dr Manish M Gandhi, manish.gandhi{at}


A 50-year-old man collapsed at the roadside with retrosternal pain, shortness of breath and generalised weakness. An ECG in the emergency department was reported as demonstrating ST segment elevation of up to 1.5 mm in leads V1 to V3, leading to a diagnosis of an acute ST-elevation myocardial infarction. He was immediately transferred to the cardiac catheterisation laboratory. Introduction of a coronary catheter produced signs that raised suspicion of aortic dissection. An aortogram revealed a grossly dilated aortic root of 7.3 cm with a type A ascending aortic dissection. The patient was urgently transferred to the cardiothoracic surgical centre and underwent emergency aortic root and ascending aorta replacement. Following a 20-day hospital admission, and postoperative atrial fibrillation, the patient made a steady and full recovery.

  • aortic dissection
  • angiography
  • ST elevation myocardial infarction
  • chest pain

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  • Contributors MMG was involved in treating the patient. AYN, AS, NMN and MMG wrote this report. The final version of the manuscript was approved by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.