The ECG

If the history suggests aortic dissection, a diagnosis of acute coronary syndrome should not be made even if the ECG has obvious STEMI or NSTEMI patterns as antiplatelet treatment, heparin or thrombolysis may worsen the prognosis of the patient.

It is always better to withhold these treatments when aortic dissection is suspected and immediately arrange for urgent aortic imaging to clarify the diagnosis.

The image displays a 12 lead ECG (click on the image to enlarge).

The following ECG features are associated with AAD:

• Non-specific ST segment and T wave changes (40% of patients)
• Acute ischaemic changes (15% of patients)
• ST elevation myocardial infarction pattern (occurs in 3% of patients due to extension of the dissection process into a coronary ostium)

Only 30% of patients with AAD will have a normal ECG.