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Critical Care: Student/Resident Case Report Poster - Critical Care II |

Spontaneous Multi-Vessel Coronary Artery Dissection

Michael Goldfarb, MD
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McGill University, Cote St Luc, QC, Canada


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4_S):389A. doi:10.1016/j.chest.2016.08.402
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SESSION TITLE: Student/Resident Case Report Poster - Critical Care II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Spontaneous multi-vessel coronary artery dissection is exceedingly rare. The optimal management strategy is currently unknown.

CASE PRESENTATION: A 50-year-old man with no past medical history presented with a 9 month history of intermittent chest discomfort on exertion. Initial physical exam was unremarkable and cardiac enzymes were not elevated. ECG showed 2 millimetre convex anterior ST elevation with reciprocal ST depressions. Coronary angiography showed dissection of the proximal left anterior descending artery (LAD) (figure 1), the ostial circumflex artery extending into the left main coronary artery and the entire right coronary artery. There was no aortic root disease. The left ventricular ejection fraction was 20-25%. The Heart Team decided not to attempt percutaneous intervention, nor intervene surgically due to poor distal targets. The hospital stay was complicated by episodes of pulseless ventricular tachycardia requiring emergent defibrillation. A repeat angiogram showed partial recanalization of the LAD. Percutaneous intervention was again discussed but not pursued. The patient improved with supportive management and was discharged home with good functional status. Subsequent serologic and genetic testing for connective tissue disorders did not reveal an identifiable cause.

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