Fibromuscular Dysplasia Leading to Spontaneous Coronary Artery Dissection with Sudden Cardiac Arrest

A 30-year-old previously healthy female, who was six-week postpartum, experienced sudden collapse and tonic-clonic seizure. Emergency medicine services arrived at the scene and the patient was found to be in ventricular fibrillation. Advanced cardiovascular life support (ACLS) was initiated with return of spontaneous circulation. Afterwards, her initial EKG showed atrial fibrillation with rapid ventricular rate, ST elevation in leads II, III, and aVF, and ST depression in V2–V4. She was transferred to a tertiary care hospital where emergent angiogram was performed revealing obstruction of blood flow in the proximal and mid right coronary artery (RCA). A hazy and irregularly contoured appearance of the RCA was consistent with diagnosis of fibromuscular dysplasia. Subsequently, intravascular ultrasonogram (IVUS) was performed which confirmed the diagnosis of RCA dissection. Successful revascularization of the RCA was performed using two bare mental stents. After a complicated course in hospital, she was discharged in stable condition and did very well overall.

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Postpartum Sudden Cardiac Death After Spontaneous Coronary Artery Dissection in a Patient With Fibromuscular Dysplasia

Cardiology Research ◽

10.14740/cr587w ◽

2017 ◽

Vol 8 (6) ◽

pp. 327-330 ◽

Cited By ~ 1

Author(s):

Tannaz Shoja ◽

Craig Basman ◽

Suresh Jain ◽

Aditya Mangla ◽

Zoran Lasic

Keyword(s):

Coronary Artery ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Fibromuscular Dysplasia ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection

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Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia: Chicken or Egg? Which comes first?

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2021.09.020 ◽

2021 ◽

Author(s):

Whitney Faiella ◽

Helen Bishop ◽

Sharon L. Mulvagh

Keyword(s):

Coronary Artery ◽

Fibromuscular Dysplasia ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection

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Abstract 15492: Spontaneous Coronary Artery Dissection: Characterizing Presentation, Management, and Outcomes at a Large Referral Cardiovascular Center

Circulation ◽

10.1161/circ.132.suppl_3.15492 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Daniel M Shivapour ◽

Phillip Erwin ◽

Heather L Gornik ◽

Esther S Kim

Keyword(s):

Coronary Artery ◽

Fibromuscular Dysplasia ◽

Patient Characteristics ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Young Females ◽

Vascular Ultrasound ◽

Time Period ◽

Cardiovascular Center

Introduction: Non-atherosclerotic spontaneous coronary artery dissection (SCAD) primarily affects women and may be associated with arteriopathies such as fibromuscular dysplasia (FMD). We aimed to describe patient characteristics, management, and outcome of SCAD at a large referral center. Methods: We queried our institutional cardiac cath database for SCAD diagnoses from 2000-2014. The electronic medical record was also queried for consecutive SCAD patients seen in a specialty arteriopathy clinic from 2010-2015. Details regarding presentation, treatment, and outcome of SCAD were collected. Trends in management over two time periods (2000-2009, 2010-2015) were compared. Results: There were 96 SCAD events in 75 patients (16 patients had one recurrence, one had three events, and one had four distinct events). Mean age at presentation was 47 years, 83% were female, and 84% presented with ACS. The LAD was the most commonly affected vessel (54%). Most SCAD events were treated medically (52%). Of 41 events treated with PCI, 19 were complicated by hematoma extension. Four PCI patients required subsequent CABG. Imaging of other arterial beds increased over time, with 2/3 patients receiving vascular ultrasound to evaluate for renal or carotid FMD in the more recent time period (Table). Of those evaluated for FMD, 45% had imaging findings compatible with multifocal FMD. Significant carotid tortuosity was present in 38%, with four demonstrating a classic “S surve” appearance recently shown to be a variant presentation of FMD. All patients survived to index hospitalization discharge, however, 24% of patients had at least one recurrence. Conclusions: SCAD affects predominantly young females and often manifests as ACS. Findings of FMD or carotid tortuosity are frequent and recognition of SCAD as a potential manifestation of FMD is increasing in our institution. In support of other reports, recurrence of SCAD is not rare and PCI attempts are complicated nearly half of the time.

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