Critical aortic stenosis presenting as STEMI

Ying X Gue,Damian J Kelly,Sanjay S Bhandari

doi:10.1530/erp-17-0017

Abstract

SummaryA 73-year-old male was brought into hospital with chest pain and inferior ST elevation on ECG. The patient immediately proceeded to the catheter lab for primary percutaneous coronary intervention. Angiography did not identify any culprit lesions to account for the patient’s electrocardiographic changes and ongoing symptoms of chest pain. Bedside echocardiography revealed critical aortic stenosis. Intra-aortic balloon pump (IABP) was inserted, resulting in resolution of chest pain and ST-segment changes. The patient underwent successful aortic valve (AV) replacement without the need for coronary intervention. This is a rare presentation of critical aortic stenosis (AS) presenting as ST-segment elevation myocardial infarction (STEMI).

Highlights

ST-segment elevation myocardial infarction (STEMI) commonly occurs when a coronary artery becomes totally occluded by a blood clot disrupting blood flow to the myocardium
Not all cases of STEMI are due to coronary artery occlusion: in this case, critical aortic stenosis (AS) led to inadequate myocardial perfusion in the absence of demonstrable epicardial coronary stenosis or occlusion
Pain and persistent ST elevation, a pressure wire study with intravenous adenosine was performed across the left anterior descending (LAD) lesion which showed a fractional flow reserve (FFR) of 0.90, indicating that the lesion was not significantly flow limiting

Summary

A 73-year-old male was brought into hospital with chest pain and inferior ST elevation on ECG. The patient immediately proceeded to the catheter lab for primary percutaneous coronary intervention. Angiography did not identify any culprit lesions to account for the patient’s electrocardiographic changes and ongoing symptoms of chest pain. Intra-aortic balloon pump (IABP) was inserted, resulting in resolution of chest pain and ST-segment changes. The patient underwent successful aortic valve (AV) replacement without the need for coronary intervention. This is a rare presentation of critical aortic stenosis (AS) presenting as ST-segment elevation myocardial infarction (STEMI)

Key Words ff aortic stenosis ff myocardial infarction ff echocardiogram

Background

Case presentation

Discussion