A case report of ruptured abdominal aortic aneurysm presenting as an inferior ST elevation myocardial ischaemia

Ruptured abdominal aortic aneurysm (RAAA) is a life-threatening condition requiring prompt diagnosis and urgent surgical management. Misdiagnosis is common due to atypical presentations, complicating timely treatment.

This case report presents a rare instance of RAAA initially diagnosed as an ST elevation inferior myocardial infarction (STEMI). An otherwise healthy 66-year-old male presented to the emergency room with syncope while the ECG revealed ST segment elevation in the inferior leads. Urgent coronary angiography demonstrated three-vessel disease with no clear culprit lesion, leading to no intervention. An abdominal CT performed shortly afterward confirmed a ruptured infrarenal abdominal aortic aneurysm.

This case highlights the importance of considering RAAA in the differential diagnosis of patients presenting with ST segment elevation and no identifiable culprit coronary lesion.