A case of aortic dissection with transient ST-segment elevation due to functional left main coronary artery obstruction

A 48-year-old man with a history of hypertension and diabetes mellitus was hospitalized with sudden onset of severe chest pain. He was in cardiogenic shook with a systolic pressure of 60mmHg. His electrocardiogram (ECG) showe d ST-segment elevation in the precordial leads suggestive of acute anterose ptal myocardial infarction. The ST-segment returned to baseline after the s ystolic blood pressure rose to 100mmHg with the administration of sympathom imetic agents. Aortography and transesophageal echocardiography demonstrate d type A aortic dissection and aortic regurgitation. Aortography and short- axis transesophageal echocardiography showed during diastole almost complet e collapse of the true lumen of the ascending aorta caused by the intimal f lap. The patient underwent surgical repair of the aortic dissection and imp lantation of Palmaz stents in the carotid arteries. Decreased blood pressur e and the presence of aortic regurgitation accelerated the collapse of the true lumen during diastole in the ascending aorta, resulting in functional obstruction of the left main coronary artery, which may have been related t o ST-segment changes in this case.