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Cardiovascular Disease |

Spontaneous Coronary Artery Dissection Presenting as an ST Elevation MI

Sameer Chadha, MD; Ankur Lodha, MD; Bilal Malik, MD; Vijay Shetty, MD; Gerald Hollander, MD; Jacob Shani, MD
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Maimonides Medical Center, Brooklyn, NY


Chest. 2014;145(3_MeetingAbstracts):68A. doi:10.1378/chest.1783035
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Abstract

SESSION TITLE: Cardiovascular Case Report Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Spontaneous Coronary Artery Dissection (SCAD) is defined as a hemorrhagic separation of the media of the coronary artery with creation of a false lumen. It is a rare clinical entity with an estimated incidence of around 0.2% in patients undergoing cardiac catheterization for Acute Coronary Syndrome.

CASE PRESENTATION: A 38 year old male presented to our emergency department with sudden onset, substernal chest pain. He denied any associated complaints of shortness of breath, dizziness or palpitations and had no known cardiac risk factors. On examination, patient’s vital signs were stable. The respiratory and the cardiovascular exams were unremarkable. The electrocardiogram done in the ER showed ST segment elevations in leads II,III and aVF and the lab work was significant for elevated cardiac enzymes (CK-MB - 69.9 ng/ml, Troponin I - 27.23 ng/ml). Patient was rushed for an urgent cardiac catheterization which showed no obstructive coronary artery disease but revealed a spiral dissection in the mid second obtuse marginal branch of the left circumflex artery. Because of the spiral nature of the dissection, decision was made to manage the patient medically and no intervention was done. He was admitted to the Cardiac Intensive Care Unit for close monitoring. The remaining course of his stay was uneventful and a repeat cardiac catheterization done few days later showed no extension of the dissection. The patient was discharged in a stable condition and continued to do well.

DISCUSSION: SCAD was first described in a 42 year old female by Pretty in 1931 [1]. It usually affects middle-aged females and is often associated with pregnancy, use of oral contraceptives, cocaine abuse, hypertension and connective tissue disorders. The diagnosis is established by the presence of a classic ‘intimal flap’ with false lumen on coronary angiography. The subsequent expansion of this false lumen by hematoma formation or clot accumulation can compress the true lumen of the artery leading to myocardial ischemia or infarction. The management of SCAD depends upon the clinical presentation, site and extent of the dissection and territory supplied by the culprit vessel. Coronary revascularization by Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG) is usually performed when dissection involves the left main coronary artery or proximal left anterior descending artery.

CONCLUSIONS: Spontaneous Coronary Artery Dissection is a rare clinical entity which can present as ST Elevation MI in young patients.

Reference #1: Pretty HC. Dissecting aneurysm of a coronary artery in a woman aged 42. BMJ 1931;i:667.

DISCLOSURE: The following authors have nothing to disclose: Sameer Chadha, Ankur Lodha, Bilal Malik, Vijay Shetty, Gerald Hollander, Jacob Shani

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    Print ISSN: 0012-3692
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