Spontaneous Coronary Artery Dissection With Systemic Lupus Erythematosus

Abstract

Background: Spontaneous coronary artery dissection (SCAD) has been reported to be a rare cause of acute coronary syndrome and sudden cardiac death. The clinical presentation of SCAD varies from asymptomatic to sudden death. Pregnancy is associated with SCAD, and autoimmune diseases, especially systemic lupus erythematosus (SLE), may play an important role in SCAD etiology. Case Report: A 37-year-old female with hypertension, SLE, a history of preeclampsia with 3 cesarean deliveries, and an active smoking habit presented to the emergency department with chest pain. On arrival, the patient was hypertensive with blood pressure of 152/122 mm Hg and a normal heart rate and respiratory rate. Given the patient's history of SLE and preeclampsia, antiphospholipid antibodies were tested. The anti-β 2 -glycoprotein 1 immunoglobulin G concentration was elevated at 30 U/mL, and lupus anticoagulant was positive. Electrocardiogram showed minimum ST elevation in lead V2. Initial troponin was 0.1 ng/mL, with a peak of 54.5 ng/mL after 6 hours. Aspirin 325 mg was administered, and the patient underwent urgent cardiac catheterization. Intravascular angiography showed evidence of intimal flap (mid left anterior descending artery) spontaneous dissection with subintimal hematoma. The angioplasty resulted in successful stent placement in the mid left anterior descending artery. Conclusion: SCAD diagnosis is challenging and requires a high index of suspicion. This case shows the challenge of early diagnosis of SCAD and highlights its association with autoimmune diseases, specifically SLE. Early recognition of this pathology results in better outcomes.

Acute myocardial infarction due to spontaneous coronary artery dissection in a young male with systemic lupus erythematosus: A case report

“…However, there are few reports on the prevalence of SCAD caused by SLE (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Chest pain was the most common symptom and was the first manifestation in two of the aforementioned cases (21,25).…”

Systemic Lupus Erythematosus and Cardiovascular Diseases: A Systematic Review

“…Spontaneous coronary artery dissection (SCAD) is another uncommon cardiac SLE manifestation, with few case reports in the literature so far. A case report by Chaaban and Kshatriya described a case of SCAD in a 37-year-old female with hypertension, and a history of smoking, both risk factors for the disease [ 47 ]. Ullah et al systematically reviewed 10 articles about SCAD associated with rheumatologic conditions and found that many cases were related to systemic lupus.…”

A warning before the storm: Spontaneous dissection of coronary artery and abdominal aorta in a patient with recurrent miscarriages

“…4 Vasculitis has also been associated with spontaneous coronary artery dissections in systemic lupus erythematosus (SLE). 5 Vascular intima disruption has been linked to hemodynamic and hormonal changes during pregnancy and the postpartum period, which explains the preponderance of spontaneous arterial dissection in pregnant women. 6 In our patient, the former hypothesis seemed more likely.…”