Resuscitative transesophageal echocardiography identifies aortic dissection intussusception as the cause of aVR STEMI

Emergency physician use of transesophageal echocardiography (TEE) is emerging as a promising tool to aid diagnosis and treatment during resuscitation. We present a case of aVR ST-elevation myocardial infarction followed by witnessed cardiac arrest and diagnosis of aortic dissection by resuscitative TEE intra-arrest. We propose the aortic dissection caused severe aortic regurgitation, left ventricular outflow tract obstruction and coronary artery malperfusion due to intimal intussusception through the aortic valve, ultimately resulting in death. Resuscitative TEE rapidly identified this unexpected life-threatening pathology and drastically changed patient management.