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Cardiovascular Disease |

Spontaneous Coronary Artery Dissection (SCAD) in an HIV Positive Young Female

Umair Tariq, MD
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York Hospital, York, PA


Chest. 2015;148(4_MeetingAbstracts):70A. doi:10.1378/chest.2277541
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Abstract

SESSION TITLE: Cardiovascular Disease Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: SCAD is a very rare cause of acute coronary syndrome in young otherwise healthy patients with striking predilection for female gender. Several conditions have been associated with SCAD such as atherosclerosis, connective tissue disorder and during the peripartum period.

CASE PRESENTATION: 27-year-old female with a history of HIV by birth on therapy, panic attacks, asthma, marijuana use and history of cocaine use presented with sharp, non pleuritic chest pain. Patient was found to be in hypertensive emergency with systolic BP>200,first set of troponins I elevated to 4.75 and urine toxicology significant for cannabis. Initial EKG was significant for non specific changes. Physical examination was unremarkable except for oral thrush. Subendocardial Infarction was suspected and an echocardiogram was performed that was significant for normal ejection fraction and no wall motion abnormality. Patient later on had another episode of chest pain with new EKG significant for anterior STEMI. Coronary angiography showed completely occluded LAD and 90% occlusion of the diagonal and coronary intravascular ultrasound was significant for chronic dissection all the way up to mid LAD. Patient received drug-eluting stents to both LAD and Diagonal and was started on standard medication therapy.

DISCUSSION: SCAD has an incidence of 0.1% for patients who are referred for coronary angiography. Mean age of presentation is between 35-40 years and more than 70% of cases are women. Patients are often divided into three groups: peripartum, atheroscleortic and idiopathic A third of cases occur in peripartum period with peak incidence in the second week after delivery. High level of estrogens can change normal arterial wall architecture resulting in spontaneous dissections. In addition there is also an increase in cardiac output, total blood volume and straining and shearing forces during labor which can result in increased stress on arterial wall. Atherosclerosis account for about 30% of cases. Atherosclerotic plaque formation may lead to the dissection. HIV and HAART may contribute to an increased risk of cardiovascular diseases by directtly affecting the pathogenesis of atherosclerosis through inflammation and endothelial dysfunction. HIV and HAART therapy can increase the occurance of risk factors such as hyperlipidemia, insulin resistance, diabetes, fat redistribution and hypertension.

CONCLUSIONS: Recognition of dissection is quite difficult and may require multiple angiographies or intravascular ultrasounds. HIV can promote inflammation and damage endothelium, including infectionof endothelial cells, secretion of proinflammatory cytokines and secretion of viral proteins and oxidative stress.

Reference #1: Spontaneous coronary artery dissection: current insights and therapy, W. Tanis, P.R. Stella, J.H. Kirkels, A.H. Pijlman, R.H.J. Peters, and F.H. de Man

Reference #2: Myocardial infarction risk in HIV-infected patients,Calza, Leonardo; Manfredi, Roberto; Verucchi, Gabriella 2010, Mar

DISCLOSURE: The following authors have nothing to disclose: Umair Tariq

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