Spontaneous Coronary Artery Dissection in a Young Man

Abstract

Spontaneous coronary artery dissection (SCAD) is an idiosyncratic phenomenon by which a spontaneous separation of the intimal and medial layer in the coronary artery occurs with intramural hemorrhage in the absence of trauma. This intramural hematoma, in turn, leads to compression and occlusion of the arterial lumen. Unlike traumatic dissection of coronary arteries, more than half of SCAD heals spontaneously over time. SCAD is known to occur predominantly in women under the age of 50, particularly during pregnancy or peripartum period. Herein, we present a case of a 32-year-old man with an SCAD on the left anterior descending coronary artery. The discordance between clinical presentation and angiographic finding posed a unique challenge in therapeutic decision making. This case reminds clinicians that SCAD should be kept in mind as a differential diagnosis even for young men presenting with acute chest pain.

Spontaneous Coronary Artery Dissection of an Anomalous Right Coronary Artery in a Young Male

“…Additionally, illnesses, such as autoimmune or connective tissue disorders, such as Marfan's syndrome, potentially weaken the walls of arteries and allow either physical or emotional stressors to precipitate the intimal tear leading to SCAD [3]. Further, drugs, such as methamphetamine and cocaine, have been implicated and general use of recreational drugs has been loosely associated with SCAD [2].…”

“…It most commonly occurs in middle-aged women and is also associated with postpartum myocardial infarction [1]. Other risk factors include emotional stress, physical stress, and illicit drug use, including stimulants [2]. Herein, we describe a 33-year-old male patient who presented with non-ST segment elevation myocardial infarction (NSTEMI) due to SCAD close to the ostium of an anomalous right coronary artery (RCA) originating off the left aortic sinus.…”