Coronary dissection with ST elevation myocardial infarction responding to thrombolytic and conservative therapy alone

2020 ◽  
Vol 16 (4) ◽  
pp. 271-274
Author(s):  
Morteza Safi ◽  
AliReza Serati ◽  
Sepideh Emami ◽  
Mohammad Reza Movahed
Keyword(s):  
Myocardial Infarction ◽  
Clinical Judgment ◽  
Conservative Therapy ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Anterior Myocardial Infarction ◽  
Hemodynamic Compromise ◽  
Major Coronary Artery ◽  
St Elevation

In this report, we describe a case of spontaneous coronary dissection involving left anterior descending artery presenting with acute anterior myocardial infarction successfully treated with thrombolytic and conservative therapy with a suggestion that spontaneous resolution of thrombus occurred before coronary intervention could be performed. As we did not have initial angiogram due to patient’s refusal, this assumption is speculative. However, this case suggests that dissections may heal spontaneously and could be treated with conservative approach in selected cases based on best clinical judgment. It is important to realize that the clinical course of a major coronary artery dissection remains unpredictable. Therefore, cardiologists should always treat each case individually and consider coronary interventions if conservative treatment is not leading to resolution of ST elevation or in patients with hemodynamic compromise. This case is followed by discussion about conservative versus invasive management of spontaneous coronary dissections.

Spontaneous Coronary Artery Dissection in the Gulf: G-SCAD Registry

Angiology ◽  
2020 ◽  
Vol 72 (1) ◽  
pp. 32-43
Author(s):  
Amin Daoulah ◽  
Salem M. Al-Faifi ◽  
Sameer Alhamid ◽  
Ali A. Youssef ◽  
Mohammed Alshehri ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Gulf Countries ◽  
Percutaneous Coronary ◽  
St Elevation

Data on spontaneous coronary artery dissection (SCAD) is based on European and North American registries. We assessed the prevalence, epidemiology, and outcomes of patients presenting with SCAD in Arab Gulf countries. Patients (n = 83) were diagnosed with SCAD based on angiographic and intravascular imaging whenever available. Thirty centers in 4 Arab Gulf countries (Kingdom of Saudi Arabia, United Arab Emirates, Kuwait, and Bahrain) were involved from January 2011 to December 2017. In-hospital (myocardial infarction [MI], percutaneous coronary intervention, ventricular tachycardia/fibrillation, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were recorded. Median age was 44 (37-55) years, 42 (51%) were females and 28.5% were pregnancy-associated (21.4% were multiparous). Of the patients, 47% presented with non-ST-elevation acute coronary syndrome, 49% with acute ST-elevation myocardial infarction, 12% had left main involvement, 43% left anterior descending, 21.7% right coronary, 9.6% left circumflex, and 9.6% multivessel; 52% of the SCAD were type 1, 42% type 2, 3.6% type 3, and 2.4% multitype; 40% managed medically, 53% underwent percutaneous coronary intervention, 7% underwent coronary artery bypass grafting. Females were more likely than males to experience overall (in-hospital and follow-up) adverse cardiovascular events ( P = .029).

scholarly journals Clomiphene Associated Inferior STEMI in a Young Female due to Right Coronary Artery Dissection

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Feras Husain Abuzeyad ◽  
Eltigani Seedahmed Ibnaouf ◽  
Mudhaffar Al Farras
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Hormonal Therapy ◽  
Ovulation Induction ◽  
Final Diagnosis ◽  
Young Female ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
St Elevation

Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD) is an uncommon cause of myocardial infarction. It most commonly affects females in the perimenopausal age. NA-SCAD has been associated with many predisposing factors including pregnancy and hormonal therapy for both contraception and ovulation induction. The presented case is a previously healthy 41-year-old woman diagnosed with inferior ST-elevation myocardial infarction due to right descending coronary artery dissection associated with recent use of clomiphene monotherapy for ovulation induction (a previously fertile woman), which was not previously reported. Learning Objectives. Emergency physicians (EPs) should be aware about NA-SCAD as a cause of acute coronary syndrome (ACS) especially in perimenopausal women even with no risk factors. NA-SCAD occurs more commonly in the postpartum period and in females following hormonal therapy. Here, clomiphene monotherapy was reported as a possible contributing factor to NA-SCAD. Guidelines for NA-SCAD management are not up to date, and EPs should avoid some interference before the final diagnosis of the cause of myocardial infarction.

scholarly journals Spontaneous Coronary Artery Dissection – A Case Report

2018 ◽  
Vol 12 (2) ◽  
pp. 105-107
Author(s):  
Samsun Nahar ◽  
Fatema Begum ◽  
Momenuzzaman ◽  
KN Khan
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Chest Pain ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
St Elevation ◽  
The Right ◽  
Spontaneous Dissection

Spontaneous coronary artery dissection is a rather rare cause of myocardial infarction, chest pain, and sudden death.There are currently no known direct causes of this condition.Most of the reported dissections have occurred in the left anterior descending coronary artery.Herein, we report the case of a 58-year-old woman who presented at our institution with an acute ST-elevation myocardial infarction secondary to a spontaneous dissection of the right coronary artery. Primary PCIresolved the occlusion of the artery, and the patient was discharged from the hospital on medical therapy.University Heart Journal Vol. 12, No. 2, July 2016; 105-107

scholarly journals Spontaneous Coronary Artery Dissection: A Rare Threat to Young Women

2012 ◽  
Vol 32 (4) ◽  
pp. e19-e26 ◽  
Author(s):  
Linda Griego Martinez
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Young Women ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Vigorous Exercise ◽  
Early Postpartum ◽  
St Elevation ◽  
Artery Disease

Spontaneous coronary artery dissection not associated with underlying coronary artery disease is rare. When the dissection does occur, it most often is manifested as an acute ST-elevation myocardial infarction in young women. Although the condition can occur in men, most often it involves women who are in their third trimester of pregnancy or the early postpartum period or are engaging in vigorous exercise. Because little is known about spontaneous coronary artery dissection in this population of women, recommendations for treatment are the same as for treatment of acute myocardial infarction associated with atherosclerotic coronary disease.

scholarly journals A ripping bike race: spontaneous coronary dissection complicated by cardiac tamponade, unmasking vascular Ehlers-Danlos in a young man

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Inne Hendrickx ◽  
Benjamin Scott
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Tamponade ◽  
Clinical Presentation ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Ehlers Danlos Syndrome ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Danlos Syndrome ◽  
Atherosclerotic Risk Factors

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Typically, it occurs in young women without atherosclerotic risk factors. Clinical presentation ranges from chest pain to myocardial infarction, ventricular fibrillation and sudden death. We report a very rare case of a young man with ST-elevation myocardial infarction caused by SCAD, complicated by hemopericardium and recurrent cardiac tamponade. Due to this acute complication, he was diagnosed as having vascular Ehlers- Danlos syndrome.

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