Discussion
Inferior ST-elevation myocardial infarction (STEMI) secondary to an aortic mass is a rare and intricate clinical scenario that demands heightened diagnostic vigilance (6). The aorta, a vital conduit for systemic circulation, can harbor various pathologies, including tumors or thrombi, compromising coronary blood flow (7).
The challenges arise from the potential for embolic events originating from the aortic mass, leading to downstream coronary artery occlusion and subsequent myocardial infarction. The inferior distribution is a common manifestation due to the proximity of the coronary ostia, complicating the electrocardiographic interpretation (8).
Accurate diagnosis relies on a comprehensive approach. Advanced imaging modalities, particularly transesophageal echocardiography (TEE) and computed tomography angiography (CTA), offer insights into the nature and extent of the aortic mass (9). Timely recognition of this unique etiology is crucial to guide appropriate management.
Therapeutic strategies include addressing both the aortic mass and myocardial infarction. Surgical intervention may be warranted for the aortic mass, aiming to prevent embolic events and restore normal coronary perfusion. Simultaneously, myocardial reperfusion strategies, such as percutaneous coronary intervention (PCI) or thrombolytic therapy, are deployed to salvage ischemic myocardium (11).
Post-intervention, close monitoring for potential embolic complications, arrhythmias, or recurrent infarctions is essential. Anticoagulation may be indicated to mitigate the risk of further embolism from the aortic mass (12).