Complete healing of spontaneous coronary artery dissection extending from the left main trunk to the left anterior descending and the left circumflex artery

Abstract Background Spontaneous coronary artery dissection (SCAD) is a frequently underdiagnosed entity that carries a significant risk of morbidity and mortality. Spontaneous coronary artery dissection is increasingly recognized as an important cause of acute coronary syndrome (ACS) and, the majority of SCAD patients are young healthy women. Case summary A 23-year-old female G5P4 presented to the emergency room for severe sub-sternal chest pain, associated with shortness of breath. Past medical history was significant for pre-eclampsia. Initial electrocardiogram was remarkable for ST depressions in V5–V6 with inverted T waves to V1–V2. Troponin I was elevated to 1.13 ng/mL. Two-dimensional echo showed reduced left ventricular function with an ejection fraction of 40%. Cardiac catheterization showed triple vessel dissection involving the left main trunk extending into mid-left anterior descending and dissection extending from ostium of left circumflex artery into large first obtuse marginal branch. She was started on aspirin and heparin. After 48 h she was loaded with clopidogrel. Computed tomography angiography of head, neck, abdomen, and pelvis showed findings compatible with fibromuscular dysplasia. She was haemodynamically stable and symptom free and did not want surgery. She was recommended to continue dual antiplatelet therapy for 12 months and subsequently aspirin and beta blocker only lifelong. Discussion Spontaneous coronary artery dissection is a rare condition which is underdiagnosed. A thorough history and high degree of suspicion is required to diagnose in a timely manner and it should be high on differential in a postpartum female presenting with signs and symptoms of ACS.

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TCTAP C-008 Successful Resuscitation of Cardiac Arrest Caused by Spontaneous Coronary Artery Dissection in the Left Main Trunk with Cutting Balloon Angioplasty and Stenting.

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.03.213 ◽

2018 ◽

Vol 71 (16) ◽

pp. S75-S76

Author(s):

Hiroshi Okumura ◽

Kotaro Obunai

Keyword(s):

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Left Main ◽

Coronary Artery Dissection ◽

Cutting Balloon ◽

Main Trunk ◽

Successful Resuscitation ◽

Left Main Trunk ◽

Cutting Balloon Angioplasty ◽

Angioplasty And Stenting

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TCTAP C-024 Successful Resuscitation of Cardiac Arrest Caused by Spontaneous Coronary Artery Dissection in the Left Main Trunk with Cutting Balloon Angioplasty and Stenting

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.03.245 ◽

2017 ◽

Vol 69 (16) ◽

pp. S113-S114

Author(s):

Yu Fukui

Keyword(s):

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Left Main ◽

Coronary Artery Dissection ◽

Cutting Balloon ◽

Main Trunk ◽

Successful Resuscitation ◽

Left Main Trunk ◽

Cutting Balloon Angioplasty ◽

Angioplasty And Stenting

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Spontaneous coronary artery dissection of the proximal left circumflex artery: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz112 ◽

2019 ◽

Vol 3 (3) ◽

Cited By ~ 1

Author(s):

Aleksandra Pineda ◽

Josh Martin ◽

Aniket Puri ◽

Bijan Jahangiri

Keyword(s):

Coronary Artery ◽

Adverse Outcomes ◽

Artery Dissection ◽

Large Artery ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Circumflex Artery ◽

Left Circumflex Artery ◽

Coronary Syndrome ◽

Increased Risk

Abstract Background Spontaneous coronary artery dissection (SCAD) has gained attention as an important cause of acute coronary syndrome and sudden cardiac death (SCD) among women. Management strategies of SCAD differ from those of atherosclerotic disease. There is an elevated risk of complications and suboptimal outcomes in patients with SCAD undergoing percutaneous coronary interventions (PCIs). Case summary A 48-year-old woman without any traditional cardiovascular risk factors was admitted with severe central chest pain with associated dyspnoea and diaphoresis. The patient had a strong family history of SCD, affecting three female members in their 40s and 50s. Cardiac troponins were elevated. Coronary angiogram showed moderate to severe stenosis of the proximal circumflex coronary artery. Optical coherence tomography confirmed SCAD with sub-intimal haematoma. Despite significant stenosis in the proximal segment of a relatively large artery, a decision was made not to proceed with PCI. The follow-up angiogram demonstrated normal coronaries. Magnetic resonance imaging of renal arteries showed features suggestive of fibromuscular dysplasia affecting the right renal artery. Subsequent genetic counselling and gene testing were unremarkable. Discussion Conservative management of SCAD is recommended because the large majority of SCAD lesions heal naturally, whereas PCI is associated with increased risk of complications and adverse outcomes. Whether SCAD is associated with the sudden death events in our patient’s family remains unclear. It certainly raises concerns as to an inheritable condition. In the absence of post-mortem findings in her family members, we can only speculate about this representing a possible inheritable form of SCAD.

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