The patient had a proximal aortic dissection which extended into the L main coronary artery.
He infarcted his L heart and arrested.
Aortic dissection is rare and is found in 3 of 100,000 patients per year. The typical age of diagnosis is 63 with 10% occurring before age 40. The first case of aortic disseciton was in King George II of Britain who was found to have a dissection at autopsy in 1760. Surgery for aortic dissection was introduced in 1950 by DeBakey.
Pericardial tamponade is the most common cause of death from dissection. Only 1-2 % involve the coronary arteries as in our patient. Most dissections involve the R coronary.
The causes of aortic dissection include: hypertension, connective tissue disease, vasculitis, marfans( in 5-9%), turner's syndrome, syphilis, and previous open heart surgery especially with aortic valve replacement.
Surgery for aortic dissection was developed by Denton Cooley, Michael DeBakey, and Oscar Creech. DeBakey himself developed aortic dissection at age 97 and underwent surgery.
Our patient arrested post imaging and was unable to be resuscitated.
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