Spontaneous Coronary Artery Dissection Masquerading as Coronary Artery Stenosis in a Young Patient

Abstract

Patient: Male, 34Final Diagnosis: Spontaneous coronary artery dissectionSymptoms: Chest painMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Rare diseaseBackground:Spontaneous coronary artery dissection (SCAD) is primarily found in females. SCAD can have many precipitating factors such as exercise, trauma, pregnancy, drugs, and connective tissue disease. Prognosis is poor for left main stem, left anterior descending (LAD) artery, and multivessel involvement, especially for females.Case Report:We present a case of young African American male with sickle cell disease who presented with chest pain associated with shortness of breath. He was found to have non-ST elevation myocardial infarction (NSTEMI). He was diagnosed with SCAD during catheterization with the help of intravascular ultrasound imaging. Three drug-eluting stents were placed to cover the proximal LAD vessel along its whole length until resolution of the lesion. The patients’ hospital course was complicated by an additional finding of left ventricular thrombus, possibly a complication of NSTEMI, which was treated with anticoagulation to complete resolution.Conclusions:SCAD is fatal, it can proceed to cause myocardial infarction as in this particular patient’s case, and sudden death if not recognized early. It can be missed on angiography alone; further intracoronary imaging such as intravascular ultrasound and optical computed tomography should be used to confirm the diagnosis of SCAD so that early and appropriate treatment can ensue.

Spontaneous Coronary Artery Dissection: An Updated Comprehensive Review

“…The incidence and the true prevalence of SCAD remain uncertain because it is frequently undiagnosed, but studies have shown the estimated prevalence of SCAD is as high as 2.1% of all patients presenting with ACS [6]. It is most commonly seen in healthy younger women (87%-95% of SCAD) with a mean age of presentation between 44 and 55 years [2,6,7]. SCAD most commonly occurs in patients with few or no traditional cardiovascular risk factors [8,9].…”

“…The second mechanism presents as compression due to hematoma and needs imaging to differentiate from atherosclerotic stenosis [7]. Both mechanisms develop a false channel in the middle layer, which causes obstruction or compression of the vessel, leading to decreased blood flow to the heart and causing myocardial ischemia [1,2].…”

“…The clinical presentation of SCAD is similar to atherosclerotic ACS; therefore, it is often misdiagnosed as such. This is particularly dangerous as the treatment modalities, although similar, could lead to more devastating complications, especially in the setting of percutaneous coronary interventions in SCAD cases, which could cause further propagation of the dissection, leading to significant morbidity and mortality [1,2].…”

Cocaine as a Risk Factor for Heart and Vascular Disease. Part 1

“…Опубликован случай расслоения верхней брыжеечной артерии, проявлявшийся абдоминальной болью [44]. Случаи спонтанного расслоения коронарных артерий, которые наблюдаются главным образом у женщин, могут быть не распознаны при обычной ангиографии как причина стеноза, фатальны и могут приводить к развитию инфаркта миокарда и внезапной сердечной смерти [45,46].…”