Spontaneous Coronary Artery Dissection after a Natural Course for 10 Years. A Case Report.

Osaki, Junzo; Hirasawa, Kunihiko; Tateda, Kunihiko; Shibata, Junichi; Miyamoto, Noriyuki; Shishido, Toshiaki; Yamashita, Hirohisa; Onodera, Sokichi

doi:10.1253/jcj.56.955

Cited by 16 publications

(6 citation statements)

References 12 publications

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“…Conversely, there are reports where with conservative treatment spontaneous coronary artery dissection patients did well at 4 months and 10 years follow up [10,19]. In general, the long-term prognosis of the patients with spontaneous coronary artery dissection is considered favorable if they survive the acute phase [3,6,7,10,21].…”

Section: Prognosismentioning

confidence: 99%

Clinical perspectives of the primary spontaneous coronary artery dissection

Gowda

Sacchi

Khan

2005

International Journal of Cardiology

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Section: Prognosismentioning

confidence: 99%

Clinical perspectives of the primary spontaneous coronary artery dissection

Gowda

Sacchi

Khan

2005

International Journal of Cardiology

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“…Th ere are reports of patients doing well at 4 months as well as at 10 years follow-up with conservative treatment, whereas others suggest emergent coronary angiography followed by PCI or CABG as likely to off er the best prospect of survival [10]. Generally, if patients survive the acute phase, the long-term prognosis seems to be favorable [1,10].…”

Section: Discussionmentioning

confidence: 99%

Persistent spontaneous dissection of the left anterior descending coronary artery after emotional pressure

Mayr

Klug

Jaschke

et al. 2010

Wien Klin Wochenschr

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A 51-year-old woman without cardiovascular risk factors experienced severe chest pain, accompanied by ST-segment elevation in lead II, III, AVF, and V4-V6. An immediately started thrombolytic therapy in a peripheral hospital successfully eliminated the cardiac symptoms and achieved complete ST-segment resolution. Subsequent cardiac angiography revealed a longitudinal spontaneous dissection in the distal part of the left anterior descending artery. Due to the small vessel size we decided on conservative therapeutic procedure with acetyl salicylamide, clopidogrel, statin, and beta blocker. Three months later, control angiography presented no resolution of the dissection and the patient showed excellent performance on stress test with no signs of ischemia.

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“…Successful angioplasty and stenting of the angiographically unchanged chronic coronary artery dissection was undertaken 16 years after the original event, when the patient presented once again with unstable angina and a positive exercise stress test (10). Osaki et al (11) described the case of a 58-year-old man originally presenting with MI and SCAD managed conservatively with medication. On 10-year follow-up, there was no recurrence of cardiac ischemia, and repeat angiography showed that the dissection had remained unchanged (11).…”

Section: Discussionmentioning

confidence: 99%

“…Osaki et al (11) described the case of a 58-year-old man originally presenting with MI and SCAD managed conservatively with medication. On 10-year follow-up, there was no recurrence of cardiac ischemia, and repeat angiography showed that the dissection had remained unchanged (11). The authors speculated that following the acute event, the residual dissection did not result in sufficient obstruction of flow to cause further ischemia.…”

Section: Discussionmentioning

confidence: 99%

An unusual case of chronic coronary artery dissection: Did cisplatin play a role?

Ghosh

Chow

Korley

et al. 2008

Canadian Journal of Cardiology

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S pontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial ischemia (1). It is more common in younger patients and in women, and has a propensity to affect patients without traditional cardiovascular risk factors (2). The tendency to affect women in high estrogenic states suggests that the hormonal and thrombogenic status of the patient may play etiological roles in SCAD. Similar factors have been implicated in increased cardiovascular event rates observed in young patients undergoing chemotherapy for testicular cancer (3). Despite this, no cases of SCAD occurring during cisplatin-based chemotherapy for testicular cancer have been reported.The presentation, outcome and management of acute spontaneous coronary artery dissection have been described extensively (4)(5)(6)(7)(8). In all of these reports, there was either no angiographic follow-up of patients who survived the acute event or follow-up angiography demonstrated complete healing of the dissection. The long-term outcome of the dissection that persists is less well described (9,10).We report a case of chronic coronary artery dissection that had its onset during a course of bleomycin-etoposide-cisplatin therapy for testicular cancer. The implications of testicular cancer and chemotherapy, and the significance of chronic coronary artery dissection persistent on angiography will be discussed. CASE PRESENTATIONA 36-year-old man presented with a history of lightheadedness, shortness of breath and left-sided chest tightness after several minutes of playing hockey. Emergency medical services arrived at the scene and found the patient in monomorphic ventricular tachycardia at approximately 300 beats/min (Figure 1). The patient underwent electrical cardioversion, with almost immediate resolution of his symptoms. On admission to a local hospital, his troponin I peaked at 0.6 μg/L (10 times the upper limit of normal), and his electrocardiogram (ECG) showed significant Q waves in leads II, III and AVF, as well as ST depression in the inferolateral leads. The Q waves in the inferior leads were unchanged from previous ECGs recorded since July 1994. At the time of the current presentation, the patient was taking ramipril and Lipitor (Pfizer, Canada). He did not smoke and rarely used alcohol. He was started on acetylsalicylic acid, clopidogrel, enoxaparin and metoprolol by the referring centre, and was transferred to a tertiary care centre for further investigation.His medical history was relevant. At the age of 24 years he developed testicular cancer, which was treated with four cycles of chemotherapy following orchiectomy. During his last course of bleomycin-etoposide-cisplatin chemotherapy, the patient developed left chest, neck and shoulder discomfort, and presented to the hospital 12 h later. Serial ECGs revealed the development of a Q wave inferior infarction and poor R wave progression across precordial leads on serial tracings. He did not receive thrombolysis, and cardiac catheterization was not performed. He was sent home on acetylsalic...

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Spontaneous Coronary Artery Dissection after a Natural Course for 10 Years. A Case Report.

Cited by 16 publications

References 12 publications

Clinical perspectives of the primary spontaneous coronary artery dissection

Clinical perspectives of the primary spontaneous coronary artery dissection

Persistent spontaneous dissection of the left anterior descending coronary artery after emotional pressure

An unusual case of chronic coronary artery dissection: Did cisplatin play a role?

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