Spontaneous coronary artery rupture without a pericardial effusion: a diagnostic challenge

Abstract

Spontaneous coronary artery rupture (CAR) is an extremely rare, life-threatening entity. It is a challenge to make a diagnosis of CAR in the absence of pericardial effusion. We describe a case of a spontaneous rupture of the right coronary artery (RCA) without pericardial effusion that emphasises the benefit of high clinical suspicion and early diagnosis. A 60-year-old man was admitted to the emergency department, with inferior myocardial infarction. Echocardiogram was negative for a pericardial effusion. Coronary angiography revealed complete occlusion of the RCA with intraluminal dissection and extravasation of contrast into the epicardium at the mid-portion of the RCA, which suggested rupture of the RCA. The patient underwent uneventful emergency coronary artery bypass grafting. CAR should be considered as a differential diagnosis in patients with acute chest pain, even in the absence of pericardial effusion, particularly in case of inferior wall involvement.

Spontaneous Coronary Artery Rupture Causing Acute Cardiac Tamponade and Cardiogenic Shock

“…Rupture of the left and distal right coronary arteries commonly manifests as intrapericardial bleeding leading to pericardial tamponade and cardiogenic shock like this case, which may give rise to hypotension, tachycardia, dysphoric, an altered level of consciousness, and sudden death, while proximal right coronary artery rupture usually presents with a subepicardial hematoma, rather than pericardial hemorrhage. 2,7) The correct diagnosis deserves a high level of suspicion. Chest X-rays, CT scans of the chest, ECGs, echocardiograms, and cardiac enzymes were the most commonly used investigations for the diagnosis.…”

Spontaneous coronary artery rupture treated on a beating heart

“…Frequently, SCAR may be missed and underreported because the time interval of cardiac tamponade is very short, or signs of acute coronary syndrome sometimes can prevail, leading to delay in diagnosis or to misdiagnosis . The clinical presentation may differ according to the site of rupture . Proximal right coronary artery rupture usually presents with a subepicardial hematoma, rather than pericardial hemorrhage, while rupture of the left and distal right coronary arteries commonly manifests as intrapericardial bleeding leading to pericardial tamponade and cardiogenic shock.…”

“…SCAR, without any known underlying disease, is a rare disorder. [1][2][3][4] Frequently, SCAR may be missed and underreported because the time interval of cardiac tamponade is very short, or signs of acute coronary syndrome sometimes can prevail, leading to delay in diagnosis or to misdiagnosis. 1 The clinical presentation may differ according to the site of rupture.…”

“…Other causes include atherosclerosis, coronary artery aneurysm, inflammatory diseases such as Kawasaki's disease and Behçet disease, trauma, infection, and coronary artery dissection . However, primary spontaneous coronary artery rupture (SCAR) without any underlying condition is a rare disorder …”

“…1 However, primary spontaneous coronary artery rupture (SCAR) without any underlying condition is a rare disorder. [1][2][3]…”