Catheter-induced aorto-coronary artery dissection: Utility and appearance on CT coronary angiogram

HIV/AIDS is a multisystemic disorder and occurrence of cardiovascular disease is higher compared to non-HIV individuals. Spontaneous coronary artery dissection (SCAD) remains a rare and underdiagnosed cause of acute coronary syndrome (ACS), even in modern day era. SCAD is predominantly seen in young to middle aged females and present as a non-atherosclerotic cause of myocardial ischaemia, infarction or sudden cardiac death (SCD); with or without ventricular arrythmias. Ventricular tachycardia (VT) can sometimes be the initial presentation of SCAD. HIV associated arteriopathy can predispose to occurrence of SCAD. We report a case of a 38-year-old male suffering from HIV/AIDS, with no conventional risk factors presenting as VT. Coronary angiogram showed SCAD in right coronary artery without any flow limitation.

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Abstract 14194: Triple Vessel Spontaneous Coronary Artery Dissection With Coronary Artery Fibromuscular Dysplasia

Circulation ◽

10.1161/circ.142.suppl_3.14194 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Franz Schweis ◽

Ara Rostomian ◽

Derek Phan ◽

Mingsum Lee ◽

Anne Ichiuji ◽

...

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Renal Artery ◽

Fibromuscular Dysplasia ◽

Left Ventricular ◽

Artery Dissection ◽

Management Approach ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Angiogram ◽

Coronary Artery Dissection

Introduction: Spontaneous coronary artery dissection (SCAD) is a rare albeit well-established etiology of myocardial infarction and most commonly involves a single coronary vessel. We present a unique case of a patient presenting with chest pain and found to have triple vessel SCAD with associated findings suggestive of coronary artery fibromuscular dysplasia (FMD). Case Presentation: A 53 year-old woman with a past medical history of hypertension and chronic headaches presented with intermittent exertional substernal chest pain for two days. Labs were significant for an elevated Troponin-I of 0.12 ng/mL (normal < 0.04 ng/mL). Coronary angiogram revealed tortuous vessels with evidence of SCAD in multiple coronary arteries including the left anterior descending artery (LAD), posterior descending artery (PDA), and posterior left ventricular artery (PLV) (Figure A, B). Intracoronary nitroglycerin was administered during the procedure to ensure the findings were not due to coronary vasospasm. Due to the known association of SCAD and FMD, a renal angiogram was performed, which demonstrated a “beading” appearance of the right renal artery consistent with renal artery FMD. She was conservatively managed with medical therapy.A head computed tomography angiogram (CTA) was performed, which showed evidence of FMD of the bilateral vertebral arteries. A repeat coronary angiogram was performed six weeks after discharge. She was found to have complete resolution of SCAD in the LAD and PLV (Figure C, D). Interestingly, the PDA displayed a “string of beads” appearance concerning for intracoronary artery FMD (Figure D). Conclusion: Our case demonstrates evidence that coronary artery FMD may contribute to the underlying etiology of the coronary artery dissection. A conservative management approach resulted in a favorable outcome and the patient was able to avoid unnecessary intervention and potential related complications.

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Recurrent spontaneous coronary artery dissection in a middle-aged male athlete patient: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa231 ◽

2020 ◽

Vol 4 (4) ◽

pp. 1-5

Author(s):

John J Fitzpatrick ◽

Awsan Noman ◽

Nicola Ryan ◽

Dana K Dawson

Keyword(s):

Myocardial Infarction ◽

Cardiac Magnetic Resonance ◽

Coronary Artery ◽

Magnetic Resonance ◽

Young Women ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Angiogram ◽

Coronary Artery Dissection ◽

St Elevation

Abstract Background Spontaneous coronary artery dissection (SCAD) is a rare condition, mainly affecting young women. Cases in male patients are rare, especially with recurrence. Case summary A 59-year-old male non-elite athlete presented as an ST-elevation myocardial infarction following a 5-km run. Urgent coronary angiogram was normal, but cardiac magnetic resonance showed a myocardial infarction. Four years later, he experienced similar chest pain with no ST-elevation on electrocardiogram and a mild troponin rise. Urgent coronary angiogram was initially thought normal but subsequent close inspection confirmed a Type 2b SCAD. Cardiac magnetic resonance showed a small additional myocardial infarction contained within an area of acute myocardial oedema. Discussion Spontaneous coronary artery dissection is more common in young women compared to men and recurrent dissection has been rarely reported in the literature. Cohort studies have shown the rate of recurrent dissection to be 13–16%, but most of the patients in these cohorts are female. Poor data exists on the best treatment of SCAD in men, but given the presence of intramural thrombus, dual antiplatelet therapy was discontinued on the presumption that it may exacerbate an intramural bleeding process.

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A Rare Case of Multivessel SCAD Successfully Treated with Conservative Medical Management

Case Reports in Cardiology ◽

10.1155/2020/8468730 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Lance Alquran ◽

Ankita Patel ◽

Lucy Safi ◽

Ankitkumar Patel

Keyword(s):

Risk Factors ◽

Coronary Artery ◽

Medical Management ◽

Complete Resolution ◽

Rare Case ◽

Residual Disease ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Angiogram ◽

Coronary Artery Dissection

A female patient presented with severe, symptomatic multivessel spontaneous coronary artery dissection (SCAD) with no known medical history or risk factors. The affected vessels were left anterior descending artery (LAD), right coronary artery (RCA), and the ramus. She was treated with conservative medical management. Two months later, repeat coronary angiogram to evaluate for any residual disease was performed which showed near-complete resolution of all involved vessels.

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Surgery is an option in evolving myocardial infarction induced by spontaneous coronary artery dissection: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa559 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Ghaitha Al Mahruqi ◽

Hilal Alsabti ◽

Mirdavron Mukaddirov

Keyword(s):

Risk Factors ◽

Chest Pain ◽

Coronary Artery ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Angiogram ◽

Coronary Artery Dissection ◽

Severe Chest Pain ◽

Left Circumflex Artery ◽

Coronary Syndrome

Abstract Background Spontaneous coronary artery dissection (SCAD) has emerged as one of the important yet rare causes of acute coronary syndrome that primarily affect young peripartum women without cardiovascular risk factors. Despite the recent improvements in diagnosis and recognition of the importance of SCAD, it remains poorly studied and there has been no consensus of opinion regarding its optimal management. Case summary A 29-year-old breastfeeding woman presented with 1-day history of severe chest pain radiating to the jaw and both shoulders. Cardiovascular examination, 12 leads electrocardiogram, and echocardiography were normal. Troponin levels were elevated; hence, coronary angiogram was done and showed type 2 SCAD of the left anterior descending artery (LAD). The patient was managed conservatively. The next day, she started again to complain of severe chest pain and her troponin levels continued to rise. Repeated coronary angiogram revealed progression of the previous LAD dissection. Another dissection was also noticed in the left circumflex artery. Chest pain recurred over the night and her troponin levels continued to rise. An emergency coronary artery bypass grafting (CABG) was performed. The patient was doing well postoperatively and was discharged home on Day 8. Discussion Our patient presented with acute ischaemic changes secondary to SCAD. The report illustrates the risk factors, pathogenesis, diagnostic work up, and the possible therapeutic options of SCAD, which include conservative management and CABG. The management varies depending on the clinical presentation and the extent of the coronary artery dissection.

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