Spontaneous coronary artery dissection: a case report

    Authors

    Keywords

    chest pain, acute coronary syndrome, young women

    DOI

    https://doi.org/10.15836/ccar2019.254

    Full Text

    Introduction : Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Some of the predisposing factors for SCAD are atherosclerosis, peripartum period, inflammatory and connective tissue disorders, heavy exercise, and certain drugs (oral contraceptives, cocaine, etc.). ( 1 , 2 ) Case report : 38-year-old woman was admitted to hospital after being examined at a specialist dispensary. This woman, otherwise healthy, gave birth 30 days ago, which was her fourth birth. She negates hypertension and earlier heart disease. She has been smoking for 18 years now, about 10 cigarettes per day. Her brother had a heart attack last year. The complaints began 4 days before, with a sudden onset of pain behind the chest, intensity 5/10, lasting for 15 minutes. She reported to the competent institution, performed an electrocardiogram (ECG) ( Figure 1 ) and proposed to continue testing at a hospital setting. She came to the hospital after 2 days, and ECG was performed ( Figure 2 ). She was hospitalized, a positive troponin was established (82 pg/ml n.v <14), understood as acute coronary syndrome (ACS). Patient had quitted treatment on her own initiative and came to our institution the next day without any documentation. After the exam and ECG ( Figure 3 ), her husband and she were presented with the possible course and outcome of the disease. She was hospitalized and classic treatment for ACS was administrated (no fibrinolytic agent was applied). She had no chest pain. ECG without evolution ( Figure 4 ). Troponin values on the rise (180,6 ng/ml). She was scheduled emergent coronary angiography. In the evening before the scheduled coronarography, pain behind the chest bone 5/10 occurs, with elevation of the ST segment in the inferior and anterior region persisting for more than 20 minutes. The administration of nitroglycerin and intravenous nitrate is painless and pain-free, but elevation persists. She was sent urgently to the catheterization room. A spontaneous dissection of left anterior descending artery was found, and a continuation of drug therapy was proposed. At the follow-up examination a month later, she had subjectively no complaints. Coronary artery dissection is a rare cause of acute coronary syndrome but is accompanied by high mortality. Dissection should be thought of in young people with chest pain, especially in young women. Initial 12-lead electrocardiogram, 4 days before hospitalisation, revealing anterolateral ST-segment changes (in leads D1, aVL and V2-V6). 12-lead electrocardiagram shows prominent anterior T wave inversions. 12-lead electrocardiogram shows negative T-wave inversion in leads D1, D2, aVL and V2-V6. 4. ST-segment elevations in leads D2, D3, aVF and V2-V6.

    Cardiologia Croatica
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    Spontaneous coronary artery dissection: a case report

    Extended Abstract
    Issue9-10
    Published
    Pages254-255
    PDF via DOIhttps://doi.org/10.15836/ccar2019.254
    chest pain
    acute coronary syndrome
    young women

    Authors

    Maja V. Sipic*ORCID
    Snezana LazicORCID
    Dragisa RasicORCID
    Biljana KrdžićORCID
    Slavica PajovićORCID

    Full Text

    Introduction : Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Some of the predisposing factors for SCAD are atherosclerosis, peripartum period, inflammatory and connective tissue disorders, heavy exercise, and certain drugs (oral contraceptives, cocaine, etc.). ( 1 , 2 ) Case report : 38-year-old woman was admitted to hospital after being examined at a specialist dispensary. This woman, otherwise healthy, gave birth 30 days ago, which was her fourth birth. She negates hypertension and earlier heart disease. She has been smoking for 18 years now, about 10 cigarettes per day. Her brother had a heart attack last year. The complaints began 4 days before, with a sudden onset of pain behind the chest, intensity 5/10, lasting for 15 minutes. She reported to the competent institution, performed an electrocardiogram (ECG) ( Figure 1 ) and proposed to continue testing at a hospital setting. She came to the hospital after 2 days, and ECG was performed ( Figure 2 ). She was hospitalized, a positive troponin was established (82 pg/ml n.v <14), understood as acute coronary syndrome (ACS). Patient had quitted treatment on her own initiative and came to our institution the next day without any documentation. After the exam and ECG ( Figure 3 ), her husband and she were presented with the possible course and outcome of the disease. She was hospitalized and classic treatment for ACS was administrated (no fibrinolytic agent was applied). She had no chest pain. ECG without evolution ( Figure 4 ). Troponin values on the rise (180,6 ng/ml). She was scheduled emergent coronary angiography. In the evening before the scheduled coronarography, pain behind the chest bone 5/10 occurs, with elevation of the ST segment in the inferior and anterior region persisting for more than 20 minutes. The administration of nitroglycerin and intravenous nitrate is painless and pain-free, but elevation persists. She was sent urgently to the catheterization room. A spontaneous dissection of left anterior descending artery was found, and a continuation of drug therapy was proposed. At the follow-up examination a month later, she had subjectively no complaints. Coronary artery dissection is a rare cause of acute coronary syndrome but is accompanied by high mortality. Dissection should be thought of in young people with chest pain, especially in young women. Initial 12-lead electrocardiogram, 4 days before hospitalisation, revealing anterolateral ST-segment changes (in leads D1, aVL and V2-V6). 12-lead electrocardiagram shows prominent anterior T wave inversions. 12-lead electrocardiogram shows negative T-wave inversion in leads D1, D2, aVL and V2-V6. 4. ST-segment elevations in leads D2, D3, aVF and V2-V6.