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).