Spontaneous coronary artery dissection in a middle-aged woman with acute anterior myocardial infarction

Abstract

Rationale:Spontaneous coronary artery dissection is a highly unusual cause of acute coronary disease. It is a result of a hematoma formation within the outer third of the tunica media,with subsequent expansion leading to compression of the true lumen and resultant myocardial ischemia.Patient concerns:We present a case of a middle-aged woman presenting with chest pain with acute anterior myocardial infarction, who did not reveal any of the cardiovascular risk factors. Finally,when pressed further about her past history, the patient revealed she had been taking oral contraceptives for the past 2 years.Diagnoses:The diagnosis is usually confirmed by coronary angiography, but it has some limitations. If necessary, intravascular ultrasound (IVUS) may help in further examinations to reduce the incidence of erroneous diagnosis or missed diagnosis.Interventions:There is no guiding suggestion for the treatment of SCAD. The main treatment methods are 3 aspects: conservative internal medical treatment, stent implantation, coronary artery bypass grafting. The treatment strategy depends mainly on the patienst’ clinical symptoms, the hemodynamic state, and the position and quantity of the dissection. In this case,we used stent implantation treatment originally and then we resorted to medical treatment.Outcomes:After careful review and analysis, coronary arteriography results was able to prove the existence of the spiral shaped dissection. We then resorted to medical treatment and her symptoms were gradually relieved.Lessons:SCAD should be suspected in young to middle-aged women with chest pain symptoms, particularly during the perinatal period or for subjects who use oral contraceptives. Doctors should be able to obtain a detailed past history and analyze coronary angiography results carefully.

Associação Entre Anticoncepcionais Orais E Infarto Agudo Do Miocárdio: Uma Revisão Integrativa Da Literatura

“…Essa se caracteriza como uma alteração totalmente incomum de Doença Coronariana Aguda (DCA) e é mais observada em mulheres, principalmente no período perinatal ou quando usuárias de contraceptivos orais, como retrata Yang et al (2018). Tal associação está relacionada a elevação do estrogênio e da progesterona, já que as paredes das artérias ficam mais enfraquecidas pelo uso de hormônios.…”

Infarto agudo al miocardio secundario a disección coronaria espontánea biarterial: Reporte de un caso y revisión de literatura

“…La presentación más común es el síndrome coronario agudo, variando desde angina inestable hasta infarto agudo de miocardio, incluso shock cardiogénico. Su detección clínica es baja (0,1% a 0,28%) 9 , incluyendo otras formas menos frecuentes de presentación como la insuficiencia cardíaca (2% -3,9%) y el taponamiento cardíaco 8,9 . El diagnóstico se confirma mediante angiografía coronaria, donde el 67% de los casos afecta a la arteria descendente anterior, el 19% a la arteria coronaria derecha, el 14% a la arteria coronaria circunfleja y menos del 1% afecta al tronco coronario izquierdo 10 .…”

Spontaneous coronary artery dissection in patients with prior psychophysical stress: a systematic review of case reports and case series

“…Six patients had complicated PCI [14,19,52,85,90,103], for whom stenting of the mid-LAD lesion in one patient resulted in a distal expansion of the dissection followed by a retrograde extension to the ostial LAD. A multiple stenting technique was employed to manage distal extensions, and emergent CABG was subsequently performed due to the high risk of LMCA/LCx flow being jeopardized as a result of the proximal extension [85].…”

“…A multiple stenting technique was employed to manage distal extensions, and emergent CABG was subsequently performed due to the high risk of LMCA/LCx flow being jeopardized as a result of the proximal extension [85]. PCI was terminated in three patients when the guidewire passage through the false lumen suggested a SCAD diagnosis and medical management was pursued [14,19,90]. Similarly, the placement of the guidewire into the false lumen suggested the diagnosis of SCAD in another patient, which was further confirmed using IVUS.…”