title: Electrocardiographic changes in patients with type A acute aortic dissection. Incidence, patterns and underlying mechanisms in 159 cases.
abstract: BACKGROUND
  Not only symptoms but electrocardiographic (ECG) changes mimicking acute coronary syndrome as well have been known to develop in acute aortic dissection (AAD). However, detailed information is lacking.
  
  
  OBJECTIVE
  We sought to evaluate incidence, patterns, and underlying mechanisms for acute ECG changes in type A AAD.
  
  
  METHODS
  Retrospective study in a single tertiary care hospital. A total of 159 cases (mean age 65.1±14.8 years, male/female=67/92) that presented within 12 h from the onset were included. Shift of the ST segment ≥0.1 mV or changes of the T wave were considered acute ECG changes.
  
  
  RESULTS
  Acute and chronic ECG changes were observed in 49.7% and 36.5% cases, respectively. ECG was normal only in 27.0% cases. ST elevation was observed in 8.2% cases and was closely related to direct coronary involvement. ST depression and T wave changes were observed in 34.0% and 21.4% cases, respectively. Cases with ST depression or T wave changes had higher incidence of shock (65.2% vs. 28.8%, p<0.001) and cardiac tamponade (51.2% vs. 15.0%, p<0.001) compared with those without changes.
  
  
  CONCLUSIONS
  Acute ECG changes were common in type A AAD. Physicians taking care of patients with chest pain and acute ECG changes should consider the possibility of AAD before performing thrombolysis or percutaneous catheter intervention.
authors.affiliation: Division of Cardiology, Okinawa Chubu Hospital, 281 Miyasato, Uruma City, Okinawa 904-2293, Japan. kheart911@yahoo.co.jp
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Hirata
authors.forename: Minoru
authors.initials: M
authors.lastname: Wake
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kyushima
authors.forename: Takanori
authors.initials: T
authors.lastname: Takahashi
authors.forename: Jun
authors.initials: J
authors.lastname: Nakazato
authors.forename: Hidemitsu
authors.initials: H
authors.lastname: Mototake
authors.forename: Toshiho
authors.initials: T
authors.lastname: Tengan
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yasumoto
authors.forename: Eisei
authors.initials: E
authors.lastname: Henzan
authors.forename: Masao
authors.initials: M
authors.lastname: Maeshiro
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Asato
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000503:physiopathology*; D001014:Aortic Aneurysm / Q000150:complications / Q000503:physiopathology*; D002305:Cardiac Tamponade / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000503:physiopathology