Premenopausal woman with acute myocardial infarction caused by spontaneous coronary artery dissection and potential association with coronary vasospasm

Abstract

A 45-year-old premenopausal woman presented with acute myocardial infarction (MI). An intravascular ultrasound (IVUS) revealed that her distal right coronary artery was occluded by spontaneous coronary artery dissection (SCAD). She did not have any specific condition related to SCAD. At follow-up cardiac catheterization, an acetylcholine provocation test was applied to examine the etiology of SCAD, and definitive coronary vasospasm was induced with chest symptoms and significant electrocardiographic change. A Ca-channel blocker was administered and since then chest pain has subsequently so far been relieved. The current case suggests the significance of the IVUS in detecting etiology of MI in younger patients and the potential association between SCAD and coronary vasospasm.

Percutaneous coronary intervention strategy for acute coronary syndrome caused by spontaneous coronary artery dissection for relieving ongoing ischemia—Case series and literature review

“…In general, SCAD occurs in younger women, especially at the peripartum period [3,4], but our three patients were not pregnant. Of these patients, two were diagnosed with coronary vasospastic angina, suggesting an association of coronary vasospasm and SCAD [8], and one had recurrent SCAD, as previously reported [3]. In this patient, recurrence of repeated SCAD has not been observed to date after concomitant pharmacological treatment with a calcium channel blocker.…”

“…Ten days after emergency CAG, we performed pre-discharge follow-up CAG again and confirmed recovery of antegrade coronary flow at the distal LCX with repair of SCAD. At that point, administration of a calcium channel blocker was initiated because of the potential coexistence of SCAD and coronary vasospasm, which has been reported as a pathogenic cause of SCAD [8]. Six months after discharge, follow-up CAG was performed and the ergonovine provocation test showed coronary vasospasm in the LAD and LCX.…”

Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease

“…Indeed, more than 50% of stable patients with suspected angina undergoing CAG had angiographically nonobstructive coronary arteries that did not require revascularization [4,10]. In addition, despite the high prevalence of obstructive coronary artery disease (CAD) in acute myocardial infarction (AMI), up to 13% of AMI patients had nonobstructive CAD (myocardial infarction with nonobstructive coronary arteries [MINOCA]) [6,7,[12][13][14]. This high prevalence of nonobstructive CAD has recently been reported not only in Japan but also in Western countries [6,10,15,16].…”

Successful coronary intervention for spontaneous coronary dissection in a patient with fibromuscular dysplasia

“…SCAD is a rare but well-known cause of ACS and sudden cardiac death. Although a substantial proportion of SCAD cases have undetermined causes, some underlying conditions have been proposed, such as peripartum state among women, connective tissue disorders, coronary spasm, vasculitides, and intense exercise [2,[4][5][6][7][8]. Two institutes have recently reported a possible association between FMD and SCAD.…”

“…In addition to the current investigations on the predilection of SCAD for young women without atherosclerosis, recent reports have focused on fibromuscular dysplasia (FMD) concomitant with SCAD [1,3]. These reports indicated that >50% of SCAD patients have FMD formation at the carotid, renal, and iliac arteries, as determined by angiography, suggesting that SCAD is associated with a predisposition of patients to coronary artery FMD, besides vasculitides, coronary spasm, and intense exercise, as reported in previous studies [4][5][6]. Therefore, a survey of the presence of noncoronary FMD as a causative factor of ACS concomitant with SCAD is important because of the associated high recurrence of coronary dissection among patients [3].…”