A case of spontaneous multivessel coronary artery dissection presenting with acute myocardial infarction and ventricular tachycardia

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial ischemia. Multivessel SCAD is much rarer than single vessel involvement and acute coronary syndrome remains the most common clinical presentation of a patient with SCAD. It predominantly occurs in association with atherosclerosis or in the absence of atherosclerosis. We, hereby, present a case of spontaneous multivessel coronary artery dissection in a 35-year-old male patient presenting with chest pain and ventricular tachycardia following emotional stress and discuss the etiology and treatment options.

Multivessel spontaneous coronary artery dissection treated with staged percutanous coronary intervention in a non-postpartum female

“…Multiple vessel involvement is much less frequent and tends to involve the LAD and the RCA together as seen in our case 1 14. Most multivessel SCAD also occurs in the peripartum period 15…”

“…It is estimated that approximately 0.1–1.1% of acute coronary syndrome presentations are due to SCAD 2. Patients typically present with acute coronary syndrome, ventricular tachycardia, or sudden cardiac death 1 3–6. SCAD most commonly affects women and 80% are associated with the peripartum or postpartum period 6–10.…”

“…Initial presentations of SCAD were found on autopsy and it was hypothesised that expansion of the false lumen by bleeding or thrombosis compresses the true lumen which ultimately leads to ischaemia 16. Proposed mechanisms that lead to clot formation in the false lumen include an underlying inflammatory process,17 plaque rupture with disruption of the intima-media junction1 12 or hormonal changes leading to impaired collagen vascular synthesis 2…”

“…Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome with over 200 cases reported in the literature 1. Multivessel involvement is less common than single vessel disease and is found most commonly in the postpartum period.…”

Spontaneous coronary artery dissection in men presenting with acute coronary syndrome, successfully managed by intravascular ultrasound-guided percutaneous coronary intervention

“…Psychological distress has also been linked to SCAD 17 18. The role of psychological stress in causing SCAD is even less clear than that of physical exertion.…”