Introduction Spontaneous coronary artery dissection is a rare cardiovascular disease that can cause acute myocardial infarction and sudden cardiac death. The mechanism of this pathology and the optimal treatment are not fully understood. Presentation of case An acute myocardial infarction developed while a fifty five years old woman with a rectal adenocarcinoma was receiving a cisplatin and capecitabine therapy. Coronary angiography demonstrated a multivessel occlusion of coronary arteries. Discussion The authors discuss several factors that may lead to the spontaneous coronary artery dissection including chemotherapy-induced vasospasm. Chemotherapy based on the cisplatin and capecitabine intake can cause a cardiotoxic effect. Conclusion Thus, spontaneous coronary artery dissection is a disease with an extremely complex etiololy, which does not have a special treatment guide. Management should be considered individually for each case.

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The aim of this study was to summarize, systematize, and extend analysis of data of two-year clinical use of intracardiac ECG (ECG-CS) in patients with coronary artery disease.Material and methods. 131 patients with coronary artery disease who underwent a planned coronary stenting were included in a prospective study from 2018 till 2020 . Ischemia was monitored with the use of electrophysiological recording system with the following settings: combining electrodes into fi ve cathode-anode pairs with a frequency range of 30–500 Hz, signal cut-off of 1 cm, and an amplitude of 0.3 mV/cm.Results. According to the ROC-analysis, the sensitivity of the ECG-СS method in case of ST segment depression was 79.5%, the specifi city was 100%; with ST segment elevation — 83% with a specifi city of 100%, according to data obtained in 88 patients with single-vessel disease of the coronary arteries (CA). Out of 43 patients with coronary artery disease, compromise of the diagonal branch and signifi cant ischemic dynamics (p < 0.05) in the intracardiac lead CS 3–4 after stent placement in the ADA according to ECG-CS was observed in 11 (25.6%) patients, in 9 (20.9%) of which successful provisional stenting was performed, and 2 (4 .6%) patients required implantation of the second stent.Conclusion. ECG-CS is a promising method for detecting myocardial ischemia in patients with coronary artery disease and allows to optimize intervention in the area of coronary artery bifurcation.

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