Spontaneous coronary artery dissection causing acute myocardial infarction and cardiac arrest in a 25-year-old male

Perfusion ◽  
2017 ◽  
Vol 33 (2) ◽  
pp. 160-163 ◽  
Author(s):  
Fu-Lan Chang ◽  
Wei-Chun Chang ◽  
Yu-Tsung Cheng ◽  
Tsun-Jui Liu ◽  
Wen-Lieng Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Spasm ◽  
Intramural Hematoma ◽  
Acute Chest Pain ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection

A 25-year-old previously healthy male presented to our emergency room with acute chest pain and ventricular arrhythmia-related cardiac arrest. ST elevation myocardial infarction was diagnosed and coronary angiography revealed diffuse critical narrowing from the proximal to the distal left anterior descending artery. Diffuse intramural hematoma was demonstrated on intravascular ultrasound. Two stents were placed to cover the whole dissection length and flow was successfully restored. Spontaneous coronary artery dissection can be a fatal event and could be mistaken for atherosclerotic plaque or coronary spasm rather than luminal compression on coronary angiography and intravascular imaging is helpful in this condition.

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: Rare but challenging

2014 ◽  
Vol 71 (3) ◽  
pp. 311-316
Author(s):  
Biljana Putnikovic ◽  
Ivan Ilic ◽  
Milos Panic ◽  
Aleksandar Aleksic ◽  
Radosav Vidakovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Flow ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome

Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical) for this serious condition is not well-defined. Case report. A 41-year old woman was admitted to our hospital after the initial, unsuccessful thrombolytic treatment for anterior myocardial infarction administered in a local hospital without cardiac catheterization laboratory. Immediate coronary angiography showed spontaneous coronary dissection of the left main and left anterior descending coronary artery. Follow-up coronary angiography performed 5 days after, showed extension of the dissection into the circumflex artery. Because of preserved coronary blood flow (thrombolysis in myocardial infarction - TIMI II-III), and the absence of angina and heart failure symptoms, the patient was treated medicaly with dual antiplatelet therapy, a low molecular weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE) inhibitor and a statin. The patient was discharged after 12 days. On follow-up visits after 6 months and 2 years, the patient was asymptomatic, and coronary angiography showed the persistence of dissection with preserved coronary blood flow. Conclusion. Immediate coronary angiography is necessary to assess the coronary anatomy and extent of SCAD. In patients free of angina or heart failure symptoms, with preserved coronary artery blood flow, medical therapy is a viable option. Further evidence is needed to clarify optimal treatment strategy for this rare cause of acute coronary syndrome.

scholarly journals A Spontaneous Coronary Artery Dissection Case Noticed during a Primary PCI

2010 ◽  
Vol 2010 ◽  
pp. 1-3
Author(s):  
Ismail Dogu Kilic ◽  
Halil Tanriverdi ◽  
Harun Evrengul ◽  
Sukru Gur
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Artery Dissection ◽  
Primary Pci ◽  
Spontaneous Coronary Artery Dissection ◽  
Late Stent Thrombosis ◽  
Coronary Artery Dissection ◽  
Very Late Stent Thrombosis

Spontaneous coronary dissections (SCAD) can be asymptomatic or can manifest itself as any of the clinical spectrum of the ischemic heart disease. In this report, we present a 65 year old man presented with myocardial infarction in whom coronary angiography a nonocclusive SCAD was noticed in addition to a very late stent thrombosis and make a brief overview of the treatment for SCAD.

Abstract 13596: The Prognostic Impact of Spontaneous Coronary Artery Dissection in Younger Female Patients with Acute Myocardial Infarction; Report from Angina Pectoris-Myocardial Infarction Multicenter Investigations in Japan

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Takahiro Nakashima ◽  
Satoshi Yasuda ◽  
Teruo Noguchi ◽  
Seiichi Haruta ◽  
Yusuke Yamamoto ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Prognostic Impact ◽  
Coronary Risk Factors ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Clinical Prognosis

Introduction: Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial infarction (AMI). It is postulated that the patients with SCAD have good clinical prognosis because they have few coronary risk factors (CRF). However, a recent report studying the US patients with SCAD aged 18~78 years suggested that the rate of recurrence was higher than we expected. In the present study, we therefore have focused on prognostic impact of SCAD on younger female populations. Methods: A total of 16,233 AMI patients registered by 10 institutes from 1991 to 2012 were retrospectively studied. The definition of SCAD was based on the presence of medial dissection or intramural hematoma that was recognized by angiography before any catheter intervention. Results: There were 27 patients diagnosed as SCAD (male/female 1/26, age 45±9 [SD] years). The overall prevalence of SCAD was 0.17% of AMI patients. SCAD developed after physical or emotional stress in 11 patients (40.7%). The left anterior descending artery was involved in 17 patients (62.9%), among whom 4 patients had multi-vessel SCAD (14.8%). Recurrences of SCAD were shown in 9 patients (33.3%). In 4 of 9, recurrence was seen in previously unaffected coronary arteries. In young population of AMI patients (age <50), we compared clinical parameters of SCAD (n=21) with those of Non-SCAD groups (atherosclerotic, n=35). In SCAD group, the number of CRF was significantly lower than in Non-SCAD groups (SCAD, 1.0+/-0.8 vs Non-SCAD, 2.2+/-1.1, P<0.0001). In Kaplan-Meier analysis, younger female AMI patients with SCAD showed significantly higher rate of cardiac event (death, AMI and heart failure) in comparison with those without SCAD (SCAD, 11/21 vs Non-SCAD, 4/34; P=0.0002) during a median follow-up of 1557 (1-8172) days. Conclusions: The present multicenter study demonstrated that younger female AMI patients with SCAD, characterized as minimum accumulation of CRF, seem to be prone to cardiac events.

scholarly journals Spontaneous Coronary Artery Dissection and Anomalous Coronary Origin – Underlying Cause of Acute Coronary Syndrome in a Young Woman: A Case Report

2021 ◽  
Vol 7 (1) ◽  
pp. 22-26
Author(s):  
Roxana-Daiana Lazar ◽  
Abigaela Rus ◽  
Cosmin Tolescu ◽  
Renata Gerculy ◽  
Diana Opincariu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Young Patients ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Left Circumflex Artery ◽  
Coronary Syndrome ◽  
Coronary Cusp

Abstract Introduction: Spontaneous coronary artery dissection (SCAD) represents a very rare and poorly understood condition that is gaining recognition as an important cause of myocardial infarction, especially among young women. The pathogenesis of SCAD is not well established yet, but several theories have been proposed. Case presentation: We report the case of a 25-year-old woman without any history of cardiovascular disease who presented with acute anterior ST-elevation myocardial infarction (STEMI) due to the luminal obstruction generated by an intramural hematoma from a SCAD of the left main coronary artery, which was successfully treated by coronary artery stenting. Additionally, the patient presented anomalies of coronary origins (ACO) with separate emergences of the left anterior descending (LAD) artery from the left coronary cusp and the left circumflex artery (LCX) from the right coronary cusp, with no apparent clinical significance. Conclusion: SCAD should always be included in the differential diagnosis of young patients presenting with STEMI. In case of prompt diagnosis, SCAD-STEMI patients are successfully treated with percutaneous coronary intervention (PCI). Moreover, it is of vital importance to identify variants of ACO, even without clinical relevance at the moment of the acute event, in order to initiate an appropriate management, since ACO increases the risk of routine PCI.

scholarly journals Spontaneous coronary artery dissection as a cause of acute myocardial infarction with ST elevation

2021 ◽  
pp. 35-35
Author(s):  
Vladimir Ivanovic ◽  
Dragana Dabovic ◽  
Milovan Petrovic ◽  
Igor Ivanov ◽  
Marija Bjelobrk
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Intravascular Imaging ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Diagonal Branch ◽  
St Elevation

Introduction. Spontaneous coronary artery dissection (SCAD) is defined as a dissection that hasn?t occurred with atherosclerosis, trauma, or hasn?t developed iatrogenically. Case outline. A 53-year-old man admitted to the hospital due to chest pain and ischemic electrocardiographically changes (ECG). Coronarography was performed and 85% of the stenosis of the first diagonal branch (D1) was registered. During the percutaneous coronary intervention (PCI), one drug-eluting was directly implanted into the D1. About 3 hours after the intervention, the patient developed an acute myocardial infarction with ST elevation (STEMI) and recoronarography was performed. The previously implanted stent in D1 was patent without thrombi. The subocclusive stenosis of the LAD was registered and PCI was performed. After implantation of the stents into the LAD, propagation of dissection towards LCx was creating significant stenosis. Following the registration of the stenosis, PCI was performed on this branch. In order to determine the cause of acute STEMI, intravascular imaging was performed, seven days after last PCI. Optical coherence tomography showed an excellent stent apposition and expansion. In the area under the stents, in the proximal segment of LAD and LCX, showed duplication in the blood vessel wall. This duplication represents an unresorbed intramural hematoma as a consequence of SCAD. Conclusion. When performing coronarography on younger patients, women in the peripartum and patients with connective tissue disorders should think on SCAD. Usage of the intravascular imaging could reduce the number of unrecognized SCAD.

scholarly journals Pregnancy-Associated Chest Pain: A Case of Spontaneous Coronary Artery Dissection

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Vidhushei Yogeswaran ◽  
Satvik Ramakrishna ◽  
John S. MacGregor ◽  
Lucas Zier ◽  
Nora Goldschlager
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Artery ◽  
Acute Chest Pain ◽  
Artery Dissection ◽  
Postpartum Women ◽  
Multiparous Woman ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Clinical Presentations

Spontaneous Coronary Artery Dissection (SCAD) is an important cause of myocardial infarction that typically affects women without traditional cardiovascular risk factors. It is the most common cause of myocardial infarction in pregnant and postpartum women. SCAD is often underdiagnosed due to the lack of clinician familiarity, and patients with pregnancy-associated SCAD often have more severe clinical presentations than those without. We present a case of SCAD in a multiparous woman who presented with acute chest pain in the postpartum period.

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