A case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site

Abstract

Background Spontaneous coronary artery rupture (SCAR) is an extremely rare but life-threatening state. The aetiology and the pathologic findings remain to be fully elucidated. Case summary A 62-year-old woman, who had been on haemodialysis for 27 years, presented with chest discomfort worsening on deep inspiration that had been ongoing for the past 2 weeks. An echocardiogram and computed tomography showed diffuse pericardial fluid. ST elevation in the broad leads, especially in leads I, II, and aVF, and increased C-reactive peptide and Troponin I levels suggested pericarditis. The patient initially had a stable course with no medications. The chest symptoms disappeared and her vital signs were stable. On Day 13 after admission, however, she had a sudden cardiopulmonary arrest due to a cardiac tamponade. An emergency coronary angiography showed extravasation of the contrast into the epicardium from the branch of the circumflex artery. She was diagnosed with SCAR and underwent a successful coil embolization. However, she went into an irreversible coma due to the cerebral hypoxia. On Day 33, she died of pneumonia. An autopsy showed a rupture of the internal elastic layer of the coronary artery. However, no specific findings, such as aneurysm and dissection, were evident. The common atherosclerotic changes were observed. Discussion The stable condition lasting for over 2 weeks was a rare clinical course for SCAR. Long-term hypertension and dialysis would have caused the rupture of the coronary artery with common atherosclerotic changes. We should consider SCAR as one of the differential diagnoses when we observe pericardial fluid.

Sudden Cardiac Arrest Due to Spontaneous Coronary Artery Rupture - A Case Report with a Diagnostic Challenge -

“…In this patient, given the diffuse atherosclerosis in the entire coronary artery, particularly in the LAD and RCA, atherosclerotic change at the bleeding point not detectable in CAG may have been an underlying cause of SCAR ( 2 ). Although SCAR without any known underlying vascular disease is a rare entity, we believe that this disease can be missed and may be underreported due to its sudden onset and fatal outcome in a short period.…”

“…Spontaneous coronary artery rupture (SCAR) is a life-threatening disorder ( 1 ). However, since it is a rare entity, its diagnosis is often missed or delayed ( 2 ). We herein report a case of SCAR that was difficult to diagnose even with coronary angiography (CAG) and discuss its characteristics and management.…”

Case report: Spontaneous coronary artery rupture presenting with acute coronary syndrome: A rare diagnosis of common disease

“…In the reported cases, only one patient was female, and her age was 65 years ( 2 ). On another note, spontaneous coronary artery ruptures can happen at any major coronary artery and are rarely reported in the side branch ( 3 , 4 ). Moreover, cardiogenic shock and tamponade complicate SCAR more often when it originates from RCA ( 5 , 6 ).…”

A very rare complication of subacute pericarditis: a case report of spontaneous coronary artery rupture

“… 5–7 However, SCAR without a cause is extremely rare. 2 In contrast, acute pericarditis often occurs spontaneously in developed countries, and most cases are caused by viral infections. In most cases, remission can be achieved with a combination of non-steroidal anti-inflammatory drugs and colchicine.…”

“…The treatment of SCAR is usually emergency open-heart surgery in previous reports, and coil embolization has been reported in one case. 2 Transcatheter arterial embolization is used as a bail-out method for complications during percutaneous coronary intervention and can be performed more quickly and less invasively than open-heart surgery, especially when the source vessel is small, as in this case. The important disadvantage is that the use of embolic materials results in permanent loss of the vessel lumen beyond the site of deployment and subsequent infarction.…”