A Rarer Case of Spontaneous Coronary Artery Dissection causing Acute Coronary Syndrome in a Puerperal Woman: Case Report

Spontaneous coronary artery dissection is an extremely rare cause of acute coronary syndrome. Although it predominantly affects young women in the peripartum period, it can also occur in men. The left coronary artery is most frequently involved. The usual presentation is ST segment elevation myocardial infarction. Although several treatment modalities have been proposed, the optimal treatment options still remain to be established. This current case report focuses on a 40- year-old male presented with acute coronary syndrome and subsequently was found to have coronary artery dissection. DOI: http://dx.doi.org/10.3329/jemc.v5i1.21498 J Enam Med Col 2015; 5(1): 52-57

Download Full-text

Case report: spontaneous coronary artery dissection and suspicion of takotsubo cardiomyopathy in a patient presenting with T-wave inversions, severe QTc prolongation, elevated cardiac biomarkers, and apical akinesia

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa172 ◽

2020 ◽

Vol 4 (5) ◽

pp. 1-6

Author(s):

Kåre Peter Frederiksen ◽

Helle Søholm ◽

Ole Havndrup ◽

Kristina Procida

Keyword(s):

Acute Coronary Syndrome ◽

Case Report ◽

Coronary Artery ◽

Takotsubo Cardiomyopathy ◽

Cardiac Biomarkers ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Coronary Syndrome ◽

T Wave

Abstract Background In patients suspected of acute coronary syndrome, but where the coronary angiography (CAG) has shown unobstructed coronary arteries differential diagnoses include spontaneous coronary artery dissection and takotsubo cardiomyopathy. This case report presents a patient with spontaneous coronary artery dissection but diagnostic signs suspicious of takotsubo cardiomyopathy. Which leads to a consideration of the co-existence of the diseases. Case summary A 57-year-old woman was acutely admitted to the emergency ward with sudden development of chest discomfort, palpitations, and dyspnoea. At hospitalization, the electrocardiography showed T-wave inversions in I, aVL, and V2, and Troponin I was elevated. Initial echocardiography revealed apical akinesia consistent with takotsubo cardiomyopathy. Initially, a diagnosis of acute coronary syndrome or takotsubo cardiomyopathy was suspected. The patient was further diagnostically assessed with CAG including optical coherence tomography which showed spontaneous coronary artery dissection in the left anterior descending artery. At follow-up 3 months later, CAG showed a fully healed coronary artery, and repeated echocardiography showed normalization of the left ventricular function. Discussion In this case report, initially, acute coronary syndrome was suspected due to electrocardiography with T-wave inversions and elevated cardiac biomarkers. Takotsubo cardiomyopathy was suspected when echocardiography showed apical ballooning, but CAG with optical coherence tomography revealed a spontaneous coronary artery dissection. Interestingly no severe obstructions of coronary arteries were seen, and follow-up echocardiography showed fully regained myocardial function. This leads to the debate as to whether this might be a case of co-existing spontaneous coronary artery dissection and takotsubo cardiomyopathy.

Download Full-text

Spontaneous coronary artery dissection in association with cabergoline therapy

BMJ Case Reports ◽

10.1136/bcr-2020-240022 ◽

2021 ◽

Vol 14 (2) ◽

pp. e240022

Author(s):

Zia Saleh ◽

Susan Koshy ◽

Vaninder Sidhu ◽

Andrea Opgenorth ◽

Janek Senaratne

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Cardiac Risk ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Coronary Syndrome ◽

Ergot Derivative

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognised cause of acute coronary syndrome. While numerous risk factors are associated with SCAD, one potential cause is coronary artery vasospasm. The use of cabergoline—an ergot derivative and dopamine agonist that may induce vasospasm—has been associated with SCAD in one other case report worldwide. Here, we describe SCAD in a 37-year-old woman on long-term cabergoline therapy with no other cardiac risk factors. Cabergoline-induced SCAD should be considered in patients presenting with an acute coronary syndrome who are treated with this medication.

Download Full-text

Spontaneous coronary artery dissection in young female acute coronary syndrome patients: a single-centre retrospective cohort study

Acta Cardiologica ◽

10.1080/00015385.2020.1778373 ◽

2020 ◽

pp. 1-5

Author(s):

Frederic De Roeck ◽

Benjamin Scott ◽

Carl Convens ◽

Paul Vermeersch

Keyword(s):

Acute Coronary Syndrome ◽

Cohort Study ◽

Coronary Artery ◽

Retrospective Cohort ◽

Young Female ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Single Centre ◽

Coronary Artery Dissection ◽

Coronary Syndrome

Download Full-text

P715 When "wait and see" is the best option: a case report of a spontaneous coronary artery dissection

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.388 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Castelo ◽

T Silva ◽

R Ramos ◽

A Fiarresga ◽

R Moreira ◽

...

Keyword(s):

Risk Factors ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Coronary Syndrome ◽

Luminal Narrowing ◽

Angio Ct ◽

Spontaneous Dissection

Abstract Introduction Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and is now being identified more frequently, in part because of increased awareness. Case report We present the case of a 63-year-old female, without cardiovascular risk factors or relevant past medical history. She complained of atypical chest pain in the last year. The patient was admitted due to acute chest pain at rest, hemodynamically stable, with unremarkable physical examination, including absence of heart failure signs. The EKG revealed a dynamic ST depression in leads V4-V6. The peak of high sensitivity troponin I was 13744pg/mL (ULN< 15.6) and CK 874U/l (ULN <168). The echocardiogram showed preserved left ventricular ejection fraction and hypokinesia of mid-apical segments of anterior wall. Considering the diagnosis of NSTEMI the patient underwent coronary angiography that revealed luminal narrowing of 70% in left main artery, 70% in proximal anterior descending artery (LAD) and 99% in first obtuse marginal. Given the absence of cardiovascular risk factors, the smooth angiographic appearance of coronary lesions and absence of calcium, we suspected of spontaneous dissection or vasculitis. Considering the absence of angina revascularization was delayed. A first coronary angio-CT confirmed the luminal narrowing and suggested a spontaneous dissection. Two weeks later the coronariography and the angio-CT were repeated with a significant improvement, showing only intermediate stenosis of proximal LAD. The additional imaging study revealed a 45mm ascending aortic dilation and a left primitive carotid stenosis without other vascular territory alterations, excluding fibromuscular dysplasia. The auto-immune study was unremarkable. With all these results it was assumed the diagnosis of a spontaneous coronary artery dissection and the patient was discharged asymptomatic under single antiplatelet therapy and Rivaroxaban. Three months later a new coronary angio-CT showed no significant coronary artery stenosis and the patient was asymptomatic. Discussion and conclusion The recognition of spontaneous coronary artery dissection is essential to the correct management of these cases because, unlike acute coronary syndrome due to atherosclerotic disease, the results of revascularization in these patients are suboptimal and conservative management is probably the best option. Abstract P715 Figure. angio-CT

Download Full-text