Acute myocardial injury with normal coronary arteries in a young male: a case report of aortic dissection with rapidly progressive aortic regurgitation

Type A aortic dissection (TAAD) is a life-threatening condition that often presents diagnostic challenges, particularly when mimicking acute myocardial infarction (AMI). This case report describes a 31-year-old male with a history of fever and no cardiovascular history who presented with acute chest pain and rapidly developed hemodynamic instability. Initial assessments revealed mild aortic regurgitation (AR) and ascending aortic dilation but no aortic dissection was reported. ECG showed ST-segment changes, yet coronary angiography ruled out obstructive coronary disease. Serial daily echocardiograms demonstrated rapid progression of AR from mild to severe within 72 h, accompanied by worsening left ventricular dysfunction. Reassessment of aortic CT confirmed TAAD with left main coronary artery involvement. Different elements of his presentation suggested possible other diagnoses, including TAAD, AMI and myocarditis. We discuss how evaluating these other diagnostic possibilities led to the correct diagnosis. This case underscores the diagnostic pitfalls of TAAD masquerading as AMI, it demonstrates the need to consider aortic dissection in patients with AMI and/or emerging diastolic murmurs of AR.