*Corresponding author email: lshankar2@hotmail.com Symbiosis Group Symbiosis Group Symbiosis www.symbiosisonline.org www.symbiosisonlinepublishing.com Pseudocoarctation of Aorta with Aneurysmal Dilatation with Acute Coronary Syndrome Shankar Laudari 1* , Madhu Gupta 2 , Sachin Dhungel 1 , Rajesh Panjiyar 2 , Pawina Subedi 3 , Ghimire Bindesh 3 and Subramanyam G 4 1 Lecturer, Department of Cardiology, College of Medical Sciences-Teaching Hospital, Bharatpur, Nepal 2 DM Resident, Department of Cardiology, College of Medical Sciences-Teaching Hospital, Bharatpur, Nepal 3, Medical Officer, Department of Cardiology, College of Medical Sciences-Teaching Hospital, Bharatpur, Nepal 4 Professor, Department of Cardiology, College of Medical Sciences-Teaching Hospital, Bharatpur, Nepal American Journal of Cardiovascular and Thoracic Surgery Open Access Case Report Non-structured Abstract Pseudocoarctation of the aorta is a very rare congenital anomaly characterized by kinking or buckling of the aorta at the level of the ligamentum arteriosum without a pressure gradient across the lesion [1]. Here, we report a case of pseudocoarctation of aorta with aortic aneurysmal dilatation presenting with acute coronary syndrome which is described as one of the rarest combination. Keywords: Pseudocoarctation; Aneurysmal dilatation; Acute coronary syndrome Received: 29 June,2017; Accepted: 06 July, 2017; Published: 14 July, 20177 *Corresponding author: Shankar Laudari, Lecturer, Department of Cardiology, College of Medical Sciences-Teaching Hospital, Bharatpur, Nepal, Tel: 977-9845112909; E-mail: lshankar2@hotmail.com Introduction Pseudocoarctation of aorta consists of an elongated arch with a kink at the level of the isthmus. It is thought to have been first described by Dotter, Steinberg, Souders and co-workers in 1951 [2,3]. Its exact etiology is not well known. One proposed embryologic cause is a failure of compression of the third through the seventh segments of the dorsal aortic roots and the fourth arch segment [1]. This condition does not cause obstruction or a gradient across the kinked segment; hence there is an absence of hemodynamic abnormalities. The four major features of pseudocoartation of aorta are i) abnormal posterolateral chest radiograph ii) < 25 mmHg pressure gradient across narrowed segment. iii) No evidence of increased collateral circulation or rib notching and iv) a diagnostic aortogram [4]. We describe a very interesting case of pseudocoarctation of aorta with aneurysmal dilatation who was referred to our center for management of acute myocardial infarction. Case Summary 63 years male with past history of Type II DM and systemic hypertension developed acute chest pain 15 days back. Clinical evaluation, electrocardiography, echocardiography and myocardial enzymes were suggestive of acute ST elevation myocardial infarction. He was managed with medical treatment. His chest pain gradually subsided but had mild chest discomfort on exertion only. During hospital stay, he had few episodes of syncopal attack. So, he was referred to our center for further management. On examination, patient was fair looking, average built and co-operative. BP on supine position was 110/70 mmHg in both the upper limbs taken on brachial artery, and 104/60mmHg in bilateral lower limbs taken on dorsalis pedis artery. Standing BP was 100/60mm Hg taken at 2 and 5 mins interval. There was no evidence of postural hypotension. ABI is > 1. Pulse was 76 beats/ min, regular, normal in volume and character, no radio-radial or radio-femoral delay and all the peripheral pulses were palpable. Jugular venous pressure was normal. Electrocardiogram was suggestive of fully evolved anteroseptal wall myocardial infarction with lateral wall ischemia in sinus rhythm as shown in Figure 1. Figure 1: Electrocardiogram showing Q waves with ST elevation in V1- V4 with T inversion in I, AVL, V5, V6 in sinus rhythm Chest X-ray was done which is suggestive of mild cardiomegaly with rotated film without ribs notching as shown below in Figure 2.