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Course: A Patient in His 50s With Chest Tightness and Left Arm and Neck Tingling

CME Credits: 1.00

Released: 2022-10-12

A man in his 50s with a history of tobacco misuse presented to the emergency department with 30 minutes of chest tightness, light-headedness, and a tingling sensation radiating to his left arm and neck. Initial vital signs included a heart rate of 72 beats per minute, blood pressure of 174/83 mm Hg, and oxygen saturation of 100% on room air. Electrocardiogram revealed normal sinus rhythm with anterior ST elevation and inferolateral reciprocal ST depression. The patient was taken emergently to the cardiac catheterization laboratory. Coronary angiography (, A) suggested that the cause of the patient’s symptoms was not acute plaque rupture, but rather, aortic dissection, which was confirmed via bedside transthoracic echocardiogram. The patient was transferred to our surgical center, where intraoperative transesophageal echocardiogram revealed a Stanford type A dissection of the ascending aorta, extending into the right coronary artery ostium (, B)., The patient underwent successful repair with aortic root, arch, and valve replacement, left coronary artery reimplantation, proximal ligation, and saphenous vein grafting to the right coronary artery.,


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