Rupturing Abdominal Aneurysm Presenting as Acute Coronary Syndrome

A 61-year-old male presented to the emergency ward with pain in his upper abdomen. Due to an abnormal electrocardiogram (ECG) and elevated cardiac enzymes the cardiologist was consulted to exclude cardiac pathology. The consulting cardiologist advised to exclude an abdominal diagnosis before treating the condition as an acute coronary syndrome (ACS). Before noninvasive imaging had been performed, the clinical situation deteriorated and an emergency laparotomy revealed a ruptured aortic aneurysm. Despite immediate revascularization multiple organ failure ensued and the patient died a few days later. This case illustrates that the suspicion of ACS should never delay the investigation of other life-threatening disorders. Contrarily angina, ECG abnormalities, and myocardial ischemia are all well known to concur with major vascular, intra-abdominal, intra-cranial, and pulmonary pathology; hence these other life-threatening conditions should always be considered and preferably be ruled out prior to further investigation and treatment of ACS.