A patient presenting with acute heart failure: A dilemma of diagnosis

Acute dyspnea is a major complaint of patients admitted to cardiology and emergency departments (ED). Acute dyspnea can be life-threatening, and is seen in cases of asthma, pulmonary embolism, acute heart failure and myocardial infarction. The present case is that of a 32-year-old man admitted to the ED with orthopnea position and agitation. Physical examination, electrocardiogram (ECG), transthoracic echocardiogram (TTE), contrastenhanced computed tomography (CECT) of thorax and coronary angiography (CAG) helped to rule out chest disease pathologies such as pneuomo-thorax, pulmonary embolism and coronary artery disease, but were not enough to make an appropriate diagnosis in this case. Because of high pretest probability of aortic dissection, transesophageal echocardiography (TEE) was performed and a diagnosis of Stanford type A dissection closing left main coronary artery (LMCA) ostia from beat to beat was made.

Akut Kalp yetmezlikli bir hasta; Taný Ýkilemi

Acil servis ve kardiyoloji baþvurularýnda akut dispne temel þikayetlerdendir. Akut dispne genellikle hayatý tehdit eden bir durum olup astým, pulmoner emboli, akut kalp yetmezliði ve miyokard enfarktüsünde görülür. Burada acilimize ortopne ve ajitasyon ile kabul edilen 32 yaþýnda bir erkek hasta olgu sunumu olarak anlatýldý. Bu olguda fiziki muayene, elektrokardiyogram, ekokardiografi, kontrastlý tomografi ve koroner anjiyografi akciðer patolojilerinden pnomotoraks, pulmoner emboli ve koroner arter hastalýðýný dýþlamamýza yetti ancak uygun taný için yeterli olmadý. Aort diseksiyonu þüpesi devam ettiði için tranözefajial ekokardiyografi yapýldý. Hastada atýmdan atýma sol ana koronerin aðzýný kapatan flep imajý izlendi.