Acute Coronary Syndrome vs Aortic Dissection
Acute Coronary Syndrome and Aortic Dissection are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Acute Coronary Syndrome vs Aortic Dissection at a glance
- Acute Coronary Syndrome: Spectrum of acute myocardial ischemia: unstable angina → NSTEMI → STEMI.
- Aortic Dissection: Intimal tear with blood propagating in the aortic media — Stanford A surgery, Stanford B medical unless complicated.
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Side-by-side comparison
| Feature | Acute Coronary Syndrome | Aortic Dissection |
|---|---|---|
| At a glance | Spectrum of acute myocardial ischemia: unstable angina → NSTEMI → STEMI. | Intimal tear with blood propagating in the aortic media — Stanford A surgery, Stanford B medical unless complicated. |
| Classic presentation | Levine's sign (clenched fist over sternum); cool/clammy skin; bradycardia in inferior MI.; Substernal chest pressure, tightness, or 'heaviness' (classic),… | Sudden, severe, tearing or ripping chest pain that radiates to the back/interscapular region (anterior chest for type A, between scapulae for type B); Maximum… |
| Workup / key labs | STEMI: ≥1 mm ST elevation in 2 contiguous limb leads OR ≥2 mm in 2 contiguous precordial leads (V2-V3 thresholds vary by age/sex), or new LBBB with clinical… | Stanford A: involves ascending aorta (regardless of distal extent) — surgical emergency. Stanford B: confined to descending aorta distal to the left… |
| Imaging | 12-lead ECG within 10 minutes of arrival — repeat every 15-30 min if initial nondiagnostic; Portable CXR (look for pulmonary edema, widened mediastinum to… | CT angiography of chest/abdomen/pelvis — first-line in hemodynamically stable patients (defines extent, identifies branch involvement, planning);… |
| First-line treatment | Aspirin 325 mg chewed immediately; P2Y12 inhibitor loading dose: ticagrelor 180 mg, clopidogrel 600 mg, or prasugrel 60 mg (prasugrel only if known anatomy… | ABCs, 2 large-bore IVs, type and crossmatch, ICU admission; AGGRESSIVE blood pressure and heart rate control FIRST — target HR <60 and SBP 100-120 mmHg; IV… |
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