Acute Coronary Syndrome Secondary to Acute Aortic Dissection – Underlying Mechanisms and Possible Therapeutic Options

Acute coronary syndrome(ACS) and acute aortic dissection(AAD) are life-threatening conditions which can be difficult to differentiate in the emergency room because of the similarity of clinical presentations. In addition, ACS can be caused in AAD as a complication of the dissecting process. Usual form of ACS is caused by an obstruction of the epicardial coronary arteries, which is initiated with the rupture of an unstable atherosclerotic plaque complicated with subsequent thrombus formation(Libby , 2001). On the other hand, ACS secondary to AAD is caused by malperfusion of the coronary artery by an obstruction of the orifice as a complication of the dissecting process. If AAD is compicated with ACS, prognosis becomes worse and the treatment of choice may be totally different from usual ACS. Medications and procedures which are usually used in cases of ordinary ACS, such as Heparin, antiplatelets, thrombolytic agents and catheter interventions, may be harmful in ACS secondary to AAD. So it is of great importance to make a correct diagnosis of ACS secondary to AAD for better treatment and survival.