Ruptured Sinus of Valsalva Aneurysm Presenting as Acute Coronary Syndrome with Cardiogenic Shock and aVR ST-Elevation - A Case Report.

Abstract

A ruptured sinus of Valsalva aneurysm can present as a clinical emergency and can lead to progressively deteriorating dyspnea. We describe an unusual case of sinus of Valsalva aneurysm (SOVA) presenting with acute chest pain and dyspnea with electrocardiographic ST-segment elevation in the V1 and aVR leads. Diagnostic angiography and cardiac computed tomography angiography showed contrast enhancement from the aorta to the right ventricle and pulmonary artery. The patient was referred to a cardiovascular surgeon for immediate surgical excision and repair. This case highlights the importance of physical examination and echocardiography, especially in the emergency setting, since the disease can manifest in various presentations. To the best of our knowledge, this report may be the first described case to suggest an acute coronary syndrome with aVR ST-elevation occurring from an acute ruptured SOVA.