Myocardial infarction with huge mural thrombus due to spontaneous coronary artery dissection detected by 64-multidetector computed tomography

2008 ◽  
Vol 127 (2) ◽  
pp. e73-e75 ◽  
Author(s):  
Sang Min Park ◽  
Kwang Kon Koh ◽  
Jeong Ho Kim ◽  
Kyu Hyun Yoon ◽  
Wook-Jin Chung ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Computed Tomography ◽  
Coronary Artery ◽  
Multidetector Computed Tomography ◽  
Artery Dissection ◽  
Mural Thrombus ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection

Recognition of acute myocardial infarction caused by spontaneous coronary artery dissection of first septal perforator

2021 ◽  
Author(s):  
Scott W Sharkey ◽  
Mesfer Alfadhel ◽  
Christina Thaler ◽  
David Lin ◽  
Meagan Nowariak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Acute Chest Pain ◽  
Vancouver General Hospital ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Septal Perforator

Abstract Aims  Spontaneous coronary artery dissection (SCAD) diagnosis is challenging as angiographic findings are often subtle and differ from coronary atherosclerosis. Herein, we describe characteristics of patients with acute myocardial infarction (MI) caused by first septal perforator (S1) SCAD. Methods and results  Patients were gathered from SCAD registries at Minneapolis Heart Institute and Vancouver General Hospital. First septal perforator SCAD prevalence was 11 of 1490 (0.7%). Among 11 patients, age range was 38–64 years, 9 (82%) were female. Each presented with acute chest pain, troponin elevation, and non-ST-elevation MI diagnosis. Initial electrocardiogram demonstrated ischaemia in 5 (45%); septal wall motion abnormality was present in 4 (36%). Angiographic type 2 SCAD was present in 7 (64%) patients with S1 TIMI 3 flow in 7 (64%) and TIMI 0 flow in 2 (18%). Initial angiographic interpretation failed to recognize S1-SCAD in 6 (55%) patients (no culprit, n = 5, septal embolism, n = 1). First septal perforator SCAD diagnosis was established by review of initial coronary angiogram consequent to cardiovascular magnetic resonance (CMR) demonstrating focal septal late gadolinium enhancement with corresponding oedema (n = 3), occurrence of subsequent SCAD event (n = 2), or second angiogram showing healed S1-SCAD (n = 1). Patients were treated conservatively, each with ejection fraction >50%. Conclusion  First septal perforator SCAD events may be overlooked at initial angiography and mis-diagnosed as ‘no culprit’ MI. First septal perforator SCAD prevalence is likely greater than reported herein and dependent on local expertise and availability of CMR imaging. Spontaneous coronary artery dissection events may occur in intra-myocardial coronary arteries, approaching the resolution limits of invasive coronary angiography.

scholarly journals Spontaneous coronary artery dissection diagnosed by multislice computed tomography

2013 ◽  
Vol 1 ◽  
pp. 111-113 ◽  
Author(s):  
Hakan Gunes ◽  
Zekeriya Kucukdurmaz ◽  
Emrah Seker ◽  
Recep Kurt ◽  
İsmail Salk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Multislice Computed Tomography ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection

scholarly journals Spontaneous Coronary Artery Dissection

2015 ◽  
Vol 10 (3) ◽  
pp. 142
Author(s):  
Jacqueline Saw ◽  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Artery Wall ◽  
Coronary Artery Dissection ◽  
Intracoronary Imaging ◽  
Younger Women

Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary artery wall that is now recognised as an important cause of myocardial infarction, especially in younger women. SCAD can be elusive on coronary angiography and clinician familiarity with non-pathognomonic angiographic SCAD variants and the use of intracoronary imaging will improve diagnosis. Conservative management and long-term cardiovascular follow-up are typically recommended.

scholarly journals Spontaneous coronary artery dissection: Acute findings on coronary computed tomography angiography

2018 ◽  
Vol 8 (5) ◽  
pp. 467-475 ◽  
Author(s):  
Marysia S Tweet ◽  
Nila J Akhtar ◽  
Sharonne N Hayes ◽  
Patricia JM Best ◽  
Rajiv Gulati ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Computed Tomography ◽  
Luminal Stenosis

Background: The coronary computed tomography angiography features of acute spontaneous coronary artery dissection, an important cause of acute coronary syndrome in young women, have not been assessed. Methods: The “Virtual” Multicenter Mayo Clinic Spontaneous Coronary Artery Dissection Registry was established in 2010 and includes retrospective and prospective patient data. Retrospective assessment of acute coronary computed tomography angiography images was performed for 14 patients (16 vessels) who had images performed within two days of invasive coronary angiography diagnosis of acute spontaneous coronary artery dissection. Results: Four pertinent diagnostic coronary features of acute spontaneous coronary artery dissection were observed in order of prevalence: 1) abrupt luminal stenosis (64%); 2) intramural hematoma (50%); 3) tapered luminal stenosis (36%); and 4) dissection (14%). Additional findings include epicardial fat stranding (42%), coronary tortuosity (29%), and coronary bridge (14%). Fifty percent of patients had myocardial hypoperfusion in the myocardial distribution of the dissected coronary artery. Conclusions: We define key coronary computed tomography angiography features of acute spontaneous coronary artery dissection, the most common of which are abrupt luminal stenosis and intramural hematoma. Importantly, intramural hematoma appears similar to noncalcified atherosclerotic plaque, emphasizing the importance of invasive coronary angiography for acute diagnosis of spontaneous coronary artery dissection until the sensitivity and specificity of coronary computed tomography angiography is better understood.

A rare cause of chest pain in paediatric age: a teenager with acute myocardial infarction due to spontaneous coronary artery dissection

2022 ◽  
Vol 15 (1) ◽  
pp. e246393
Author(s):  
Filipa Costa Cascais ◽  
Ana Rita Pereira ◽  
Ana Rita Almeida ◽  
Luísa Rocha
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Warning Signs ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Paediatric Age ◽  
Life Threatening

A healthy 17-year-old boy was admitted to the emergency department presenting with a pressure-like sternal pain that started during exercise. His physical examination was normal. Twelve-lead ECG and transthoracic echocardiogram suggested a myocardial infarction. The patient was submitted to an invasive coronary angiography, which revealed a distal occlusion of the left anterior descending artery, due to a spontaneous coronary artery dissection. A balloon angioplasty was performed, with good results. Aetiological study did not discover any pathologic condition. Chest pain in paediatric age is a frequent complaint, despite not being usually caused by a serious condition. However, it is important to remember warning signs in order to diagnose life-threatening diseases, as soon as possible.

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