Challenges in Diagnosis and Management of Spontaneous Coronary Artery Dissection in a Young Patient

Abstract

Spontaneous coronary artery dissection (SCAD) is characterized by tear of the inner layer in the coronary artery, creating a false lumen between the inner and central layer. Its infrequent incidence often leads to delay in diagnosis posing challenges in management. There are currently no guidelines for the treatment of this condition. We describe an adult patient who presented with multiple episodes of ventricular fibrillation, in whom cardiac catheterization showed SCAD, treated by off-pump coronary artery bypass.

An Atypical Presentation of Spontaneous Coronary Artery Dissection

“…Again, here the patient fell into an anatomical minority with dissection of the OM3 branch of the left lateral circumflex artery dissection. As percutaneous coronary intervention has been associated with complications and poor outcomes, conservative management is the optimal treatment of SCAD patients, with repeat angiography demonstrating healing of SCAD lesions [ 1 , 3 , 4 ]. However, up to 10% of patients may experience complications including extension of the existing dissection or new dissection during the inpatient course [ 3 ].…”

“…Spontaneous coronary artery dissection (SCAD), a tearing of the intimal layer of the coronary artery, and the subsequent luminal hematoma formation is a rare cause of myocardial ischemia, accounting for only 0.4% of all forms of acute coronary syndrome (ACS) [1]. Females are predominantly affected by SCAD, contributing up to 25%-35% of cases of ACS in those less than 50 years of age [2][3][4].…”

Not Your Common Athletic Heart Problem: Using Coronary CTA to Visualize Spontaneous Coronary Artery Dissection

“…SCAD is a disease in which there is separation of the tunica intima and tunica media of the vessel wall which creates a false lumen leading to infarction. SCAD is a rare cause of ACS with an incidence in the general population of 0.1-0.4% [ 5 , 6 ]. The first reported case was in a postmortem autopsy of a 43-year-old female.…”

“…The first reported case was in a postmortem autopsy of a 43-year-old female. SCAD accounts for almost 25% of cases of infarction in women younger than the age 40 years and many cases go undiagnosed until autopsy [ 6 – 8 ]. Risk factors include physical and emotional stressors, pregnancy, fibromuscular dysplasia, and connective tissue disease [ 9 – 11 ].…”