scholarly journals A case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Daichi Fujimoto ◽  
Mitsuru Takami ◽  
Amane Kozuki ◽  
Junya Shite
Keyword(s):  
Coronary Artery ◽  
Troponin I ◽  
Cardiopulmonary Arrest ◽  
Vital Signs ◽  
Stable Condition ◽  
Pericardial Fluid ◽  
Circumflex Artery ◽  
Pathologic Findings ◽  
Atherosclerotic Changes ◽  
Coronary Artery Rupture

Abstract Background Spontaneous coronary artery rupture (SCAR) is an extremely rare but life-threatening state. The aetiology and the pathologic findings remain to be fully elucidated. Case summary A 62-year-old woman, who had been on haemodialysis for 27 years, presented with chest discomfort worsening on deep inspiration that had been ongoing for the past 2 weeks. An echocardiogram and computed tomography showed diffuse pericardial fluid. ST elevation in the broad leads, especially in leads I, II, and aVF, and increased C-reactive peptide and Troponin I levels suggested pericarditis. The patient initially had a stable course with no medications. The chest symptoms disappeared and her vital signs were stable. On Day 13 after admission, however, she had a sudden cardiopulmonary arrest due to a cardiac tamponade. An emergency coronary angiography showed extravasation of the contrast into the epicardium from the branch of the circumflex artery. She was diagnosed with SCAR and underwent a successful coil embolization. However, she went into an irreversible coma due to the cerebral hypoxia. On Day 33, she died of pneumonia. An autopsy showed a rupture of the internal elastic layer of the coronary artery. However, no specific findings, such as aneurysm and dissection, were evident. The common atherosclerotic changes were observed. Discussion The stable condition lasting for over 2 weeks was a rare clinical course for SCAR. Long-term hypertension and dialysis would have caused the rupture of the coronary artery with common atherosclerotic changes. We should consider SCAR as one of the differential diagnoses when we observe pericardial fluid.

scholarly journals A very rare complication of subacute pericarditis: a case report of spontaneous coronary artery rupture

2021 ◽  
Author(s):  
Tomotaka Fujimoto ◽  
Kenji Yanishi ◽  
Kan Zen ◽  
Satoaki Matoba
Keyword(s):  
Coronary Artery ◽  
Thoracoscopic Surgery ◽  
Cardiopulmonary Arrest ◽  
Rare Complication ◽  
Good Prognosis ◽  
Contrast Extravasation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Acute Pericarditis ◽  
St Segment Elevation ◽  
Coronary Artery Rupture

Abstract Background Spontaneous coronary artery rupture (SCAR) is an extremely rare and highly lethal disease. Case Summary A 74-year-old man who had undergone respiratory surgery (robot-assisted thoracoscopic surgery) presented with exertional dyspnoea since post-operative day (POD) 6. Echocardiography and contrast-enhanced computed tomography showed diffuse pericardial effusion, and a 12-lead electrocardiogram showed widespread concave ST-segment elevation. The diagnosis of acute pericarditis was made based on the absence of significant elevation of cardiac enzymes and the presence of elevated C-reactive peptide levels. The patient was started on anti-inflammatory medication, including steroids; however, on POD 11, the patient developed a sudden cardiopulmonary arrest due to cardiac tamponade. Extracorporeal cardiopulmonary resuscitation was performed, and an emergency coronary angiography showed contrast extravasation from the left anterior descending artery to the epicardium. He was diagnosed with SCAR and underwent transcatheter arterial embolisation (TAE) and pericardial drainage. Discussion In this case, SCAR occurred during the course of acute pericarditis. We speculated that the cause of SCAR was more affected with pericarditis than injury by the respiratory surgery. The clinical course of acute pericarditis generally has a good prognosis, but the rare occurrence of fatal complications should be considered, suggesting the need for careful follow-up. In addition, TAE was a less invasive and feasible treatment for SCAR.

Unexpected case of critical left main coronary artery dissection in a young woman

2020 ◽  
Vol 13 (9) ◽  
pp. e236379
Author(s):  
Ifrah Zahid Butt ◽  
Vahid Kazemi ◽  
Oranus Mohammadi ◽  
Mauricio Danckers
Keyword(s):  
Coronary Artery ◽  
Troponin I ◽  
Left Main Coronary Artery ◽  
Bypass Graft ◽  
Significant Risk ◽  
Stable Condition ◽  
Artery Dissection ◽  
Left Main ◽  
Coronary Artery Dissection ◽  
Persistent Symptoms

A 36-year-old woman presented with a 3-month history of recurrent substernal chest pain, which acutely worsened 2 days prior to presentation. Her initial troponin I was mildly elevated and ECG showed subtle changes initially concerning for ischaemia; however, these were present on her prior ECG and were not considered an acute change. Because of her age and lack of significant risk factors, she was considered low risk for cardiac disease and initially treated conservatively for a non-ST elevation myocardial infarction. Due to persistent symptoms and dynamic changes on ECG concerning for ischaemia, she was immediately taken for a cardiac catheterisation and was found to have critical left main coronary artery dissection with a focal stenotic lesion. She had an extensive workup to identify the underlying cause of her coronary artery dissection which was unrevealing. She underwent an uncomplicated coronary artery bypass graft surgery and was discharged home in stable condition.

scholarly journals Three broken vessels in a peripartum patient: a rare case report of spontaneous triple vessel coronary artery dissection

2020 ◽  
Vol 4 (5) ◽  
pp. 1-6
Author(s):  
Hassan Lak ◽  
Karim Abdul Rehman ◽  
Wael A Jaber ◽  
Leslie Cho
Keyword(s):  
Coronary Artery ◽  
Troponin I ◽  
Significant Risk ◽  
Left Ventricular ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Coronary Syndrome

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.

Diagnostic feasibility of resting full-cycle ratio between systole and diastole to assess functional lesion severity of intermediate coronary artery stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Takashima ◽  
H Ohashi ◽  
H Ando ◽  
S Sakurai ◽  
Y Nakano ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiac Cycle ◽  
Coronary Artery Stenosis ◽  
Stable Condition ◽  
Artery Stenosis ◽  
Lesion Length ◽  
Roc Curve Analysis ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Lesion Severity

Abstract Background Recently, non-hyperemic physiologic indices have become widespread for evaluating physiological lesion assessment. The resting full-cycle ratio (RFR) is a unique non-hyperemic index which is calculated as the point of absolutely lowest distal pressure to aortic pressure during entire cardiac cycle. It is unclear whether RFR may detect functionally significant coronary stenosis that cannot be detected with other resting indices due to differences in the cardiac cycle. The aim of this study is to compare the diagnostic performance of RFR based on cardiac cycle. Method This study was a prospectively enrolled observational study. A total of 156 consecutive patients with 220 intermediate lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis. Results In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.0±0.7mm, 45±13%, 13.0±8.8mm, 0.90±0.09, and 0.82±0.10, respectively. Functional significance was observed in 88 lesions (40%) of all lesions. RFR systole was observed in 24 lesions (10.9%). Regarding to the coronary lesions, RFR systole was more frequent in non-LAD (LAD; 4.2%, left circumflex artery (LCX); 9.8%, and right coronary artery (RCA); 30.4%, respectively, p<0.018). RFR showed a significant correlation with FFR in both systole and diastole (R = 0.918, p<0.001, R = 0.733, p<0.001, respectively). The ROC curve analysis showed similar agreement in both systole and diastole (AUC: 0.881, p<0.001, AUC: 0.864, p<0.001, respectively). RFR provided a good diagnostic accuracy and no difference in both systole and diastole (79.6% and 87.5%, respectively, p=0.58). Conclusion RFR is feasible and reliable non-hyperemic index regardless of the difference of cardiac cycle to evaluate physiological lesion severity in daily practice. Funding Acknowledgement Type of funding source: None

Idiopathic Right Coronary Artery Rupture: A Rare Diagnosis in Young Adults

2016 ◽  
Vol 64 (S 01) ◽  
Author(s):  
B. Mayr ◽  
S. Buchholz ◽  
M. Lühr ◽  
C. Hagl ◽  
M. Pichlmaier
Keyword(s):  
Young Adults ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Rare Diagnosis ◽  
Coronary Artery Rupture

Postmortem Specificity of Troponin for Acute Miocard Infarction Diagnosis throug Qualitative Dosing from Pericardial Fluid

2018 ◽  
Vol 69 (9) ◽  
pp. 2482-2486
Author(s):  
Iuliana Hunea ◽  
Simona Irina Damian ◽  
Carmen Corina Radu ◽  
Sorin Moldoveanu ◽  
Tatiana Iov
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Disease ◽  
Cardiac Death ◽  
Troponin I ◽  
Troponin T ◽  
Morphological Changes ◽  
Pericardial Fluid ◽  
Histological Changes ◽  
Lethal Arrhythmia ◽  
Myocardial Lesions

Cardiac disease is the leading cause of death, and sudden cardiac death occupies the first place in sudden deaths of natural causes. Sudden cardiac death due to lethal arrhythmia may be the first manifestation of a cardiac disease, such cases becoming suspect dead, thus forensic cases. The autopsy performed in such cases may reveal important cardiovascular disease but not obvious macroscopic or histological changes of acute myocardial infarction (IMA), except for cases of survival for several hours after the onset of the symptomatology. Biochemical markers were used to test for myocardial lesions in the absence of morphological changes. Methods for determining myoglobin, CK-MB, troponin T (cTn T), troponin I (cTn I) were introduced to the clinic to diagnose the condition of patients with chest pain as early as the 1990s. The lack of pathognomonic elements in corps investigations, where part of the analysis cannot be carried out, requires verification of the value of the investigations that can be carried out, with reference to the biochemical in the present case, in establishing the diagnosis with certainty.

Hypoplastic Left Circumflex Coronary Artery: Imaging Findings with Coronary Computed Tomography Angiography - A Case Report

2019 ◽  
Vol 15 (4) ◽  
pp. 427-429
Author(s):  
Asli Tanrivermis Sayit ◽  
Cetin Celenk
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Computed Tomography Angiography ◽  
Coronary Artery Imaging ◽  
Circumflex Coronary Artery ◽  
Circumflex Artery ◽  
Coronary Computed Tomography ◽  
True Incidence ◽  
Left Circumflex Artery ◽  
Artery Disease

<P>Background: Hypoplastic coronary artery disease is a rare congenital coronary artery anomaly. It is often detected incidentally, and its true incidence in the general population is not known. </P><P> Discussion: Symptoms of HCAD are syncope, palpitations, dyspnea, and chest pain. Also, arrhythmia and myocardial infarction can be seen; these can cause sudden death, especially in athletes and young people. Diagnosis is often made at autopsy. Conclusion: Here, we present the case of a 39-year-old male with isolated hypoplasia of the left circumflex artery detected by coronary Computed Tomography (CT) angiography who complained of palpitation.</P>

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