Aortic dissection can extend into a coronary ostium, most often the right, and present with inferior ST elevation. Giving antiplatelets, heparin or thrombolysis in that setting can be catastrophic.
When the story or examination is atypical — tearing or back pain, a pulse or blood pressure difference between arms, a new aortic regurgitation murmur, neurological signs or a widened mediastinum — pause and image the aorta before antithrombotic therapy.
- Ask about tearing chest or back pain in every suspected STEMI
- Check pulses and blood pressure in both arms
- Listen for a new aortic regurgitation murmur
- Image the aorta before antithrombotics when dissection is plausible
Why it matters
The wrong reflex in the wrong patient turns a survivable dissection into a fatal one.
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