Spontaneous Coronary Artery Dissection Causing Myocardial Infarction and Left Ventricular Aneurysm.

Abstract

pontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction (MI). We report a 66-year-old Japanese man who had had an anterior wall MI caused by SCAD of the left anterior descending (LAD) coronary artery and who later developed a left ventricular aneurysm (LVA) despite the dissection having completely disappeared. Case ReportA 61-year-old Japanese man was admitted to hospital after an anteroseptal myocardial infarction (MI), which had occurred at rest. The coronary angiogram taken at that time revealed SCAD of the LAD without significant stenosis (Fig 1), and catheter intervention was not performed. He was discharged after rehabilitation, and was followed with medication at the outpatient clinic. Five years later, echocardiography revealed a mural thrombus at the apex of the left ventricle (LV) accompanied by an aneurysm. Anticoagulant therapy with warfarin sodium was started, but the LV ejection fraction (EF) decreased and he was admitted to hospital for surgical treatment of the aneurysm and thrombus.Physical examination revealed a healthy man, 166 cm tall and weighing 69 kg. His blood pressure was 106/74 mmHg, and his pulse was 59 beats/min and regular. There were no stigma of connective tissue disorder. The electrocardiogram (ECG) confirmed the previous anteroseptal MI.Although the preoperative coronary angiogram (CAG) did not show any stenosis in the LAD and the dissection had completely healed, the left ventriculogram (LVG) showed LVA and a dilated LV with an EF of 21.3% (Fig 2).During surgery, we observed an old thrombus (3 g) in the

Clinical perspectives of the primary spontaneous coronary artery dissection

“…In addition, chest pain in patients with spontaneous coronary artery dissection is often less severe and might be of longer duration (days) [17]. The clinical spectrum reported of its presentation includes angina, myocardial infarction, heart failure, cardiogenic shock, cardiac tamponade and sudden death [2,9,18]. Left ventricular aneurysm has been reported to develop years after myocardial infarction caused by spontaneous coronary artery dissection of the left anterior descending coronary artery [18].…”

“…The clinical spectrum reported of its presentation includes angina, myocardial infarction, heart failure, cardiogenic shock, cardiac tamponade and sudden death [2,9,18]. Left ventricular aneurysm has been reported to develop years after myocardial infarction caused by spontaneous coronary artery dissection of the left anterior descending coronary artery [18]. The spontaneous coronary artery dissection should always be considered in the differential diagnosis in young persons sustaining acute precordial pain, especially the postpartum women [18].…”

“…Medical therapy with standard medications and careful follow-up has been used most often in stable patients [16,18,19,20]. In addition, coronary artery bypass, coronary catheter based interventions including stent placement, thrombolysis and glycoprotein IIB-IIIA inhibitor therapy have all been used successful, although in the acute phase, the thrombolytic therapy may be dangerous [3,14,17,[20][21][22].…”

Spontaneous Coronary Artery Dissection Mimicking Acute Aortic Dissection

“…Spontaneous coronary artery dissection can result in a broad clinical spectrum, including angina, myocardial infarction, heart failure, pericardial tamponade, cardiogenic shock, and sudden death. 13,14 Various clinical manifestations with the rarity of the disease may be the reason that it is not feasible to diagnose SCAD. Moreover, even if coronary angiography is performed, which is the gold standard for in vivo diagnosis of SCAD, many cases may appear as a simple stenosis angiographically if the classic signs of dissection, such as a radiolucent intimal flap or the presence of extraluminal radiolucent contrast after washout of dye from the remainder of the vessel, are not shown or the vessel is totally occluded.…”

A rare presentation of primary spontaneous coronary dissection: Left ventricular apical thrombus associated with ischemic cerebrovascular event

“…Left ventricular aneurysm also has been reported to develop years after myocardial infarction caused by SCAD of the left anterior descending (LAD) coronary artery [4]. To establish the diagnosis and determine the appropriate therapeutic approach, coronary angiography is indicated [2].…”