Chest Pain Radiating to the Jaw with Elevated Troponin: Aortic Dissection Masquerading as Myocardial Infarction

Sufyan AbdulMujeeb^1, , Faisal Masood¹, Dureshahwar Ali¹, Sarah Doleeb² and Adib Chaus²

¹Department of Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, USA

²Department of Cardiology, Advocate Lutheran General Hospital, Park Ridge, IL, USA

Cite this paper

Sufyan AbdulMujeeb, Faisal Masood, Dureshahwar Ali, Sarah Doleeb and Adib Chaus. Chest Pain Radiating to the Jaw with Elevated Troponin: Aortic Dissection Masquerading as Myocardial Infarction. American Journal of Medical Case Reports. 2021; 9(4):253-258. doi: 10.12691/AJMCR-9-4-12

Abstract

Introduction: Chest pain radiating to the jaw, is a classic symptom of acute myocardial infarction (AMI). Electrocardiogram (EKG) changes consistent with ischemia and elevated serum troponin I levels are used to confirm the diagnosis. Prompt management including medical or procedural intervention is required to help reduce mortality in patients with AMI. However, additional conditions may mimic those of classic primary coronary pathology. Case Report: We present the case of a 43-year-old male who came to the emergency department (ED) complaining of acute onset of chest pain radiating to the left jaw. His EKG revealed mild ST changes and T-wave inversion in the antero-lateral leads. Laboratory testing revealed an elevated serum troponin level of 0.18 ng/mL (normal: < 0.04 ng/mL). He was taken for a coronary angiogram and during the procedure, an aortogram was performed revealing a type A aortic dissection. Findings were confirmed by Computed Tomography Angiogram (CTA) showing a dissection extending from the aortic root to the iliac bifurcation. He was promptly taken to the operating room (OR) for surgical repair. Conclusion: Aortic dissection (AD) is included in the differential diagnosis in patients presenting with symptoms and signs consistent with AMI. However, in patients presenting with AD, there are some clues in history and physical exam, such as high blood pressure, history of noncompliance with antihypertensive medications, or location of pain that may provide a clue towards an underlying AD. Our case demonstrates that even if all evidence points towards an AMI, AD should still be on the differential until successfully ruled out by imaging.

Keywords

Aortic Dissection, Myocardial Infarction, Point-of-care ultrasound, POCUS

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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