Spontaneous coronary artery dissection in an antilles man with acute inferior myocardial infarction

Abstract

Spontaneous coronary artery dissection is a rare cause of myocardial infarction. It has been reported mainly in young women during or after pregnancy. The diagnosis is usually confirmed at autopsy. The management of these patients remains controversial. We report the case of a patient who presented spontaneous dissection and was with successfully treated by thrombolysis. Clinical outcome was good. © 2006 Elsevier Ireland Ltd. All rights reserved.Keywords: Coronary dissection; Myocardial infarction; Thrombolysis Spontaneous coronary artery dissection is a rare cause of myocardial infarction, occurring as complication aortic dissection or occurring after blunt, chest trauma, coronary bypass grafting, cardiac catheterisation or coronary angioplasty. The diagnosis is frequently obtained at autopsy. The management is not yet well codified. We report the case of a patient who presented spontaneous dissection, with a good outcome after thrombolysis. Case report55-year old Antilles man, without previous cardiac history, was admitted in the intensive care unit for acute inferior myocardial infarction. Physical examination revealed blood pressure of 150/90 mmHg , pulse rate of 64/min , a respiratory rate of 18/min and a normal cardiovascular examination serial electrocardiograms revealed inferior Q wave myocardial infarction, confirmed by characteristic increase and decrease of creatine-Kinase with peak serum level of 1474 IU/l. Chest X-ray was normal. He received intravenous tissue plasminogen activator 5 h after the onset of pain followed by resolution of chest pain rapid resolution and of ST segment elevation (Figs. 1 and 2). Twodimensional echocardiography revealed hypokinesia of the inferior wall. A first catheterisation was performed 12 days later. Hypokinesia of left ventricular inferior wall was found at angiography. Coronary arteriography demonstrated a floating intimal flap in the right coronary artery indicating coronary artery dissection. No atherosclerotic plaque was observed. (Fig. 3). The collagen screen was negative for auto-immune disorders. Doppler of the carotid arteries and thoracoabdominal CT scan were normal. Twelve days later, the patient was discharged from the hospital on medical therapy. Follow-upAngiographic follow-up was performed 5 months later; there was no residual sign (Fig. 4). On a subsequent treadmill test, he achieved stage 4 of a standard Bruce protocol without symptoms or inducible ischemia. Dobutamine stress echocardiography and MIBI single photon emission tomography were normal. The patient had no symptoms throughout 18-month follow-up.

The healing of spontaneous coronary artery dissection with conservative treatment: When to stop

“…e l s e v i e r . c o m / l o c a t e / i j c a r d metallic jacket covering of a long segment of the coronary artery [2,3,[6][7][8]. In our case, we did not need to attempt wiring the lesion in order to prevent the propagation of dissection and blocking the flow to the distal part of the LAD.…”

Does thrombolytic therapy harm or help in ST elevation myocardial infarction (STEMI) caused by the spontaneous coronary dissection?

“…Successful use of thrombolytic agents have been published in eight cases including our [6][7][8][13][14][15] . In 11 cases 1,4,11,16,17 , thrombolytic agents did not help to re-establish coronary flow, but only in one case complications were described that may be associated with thrombolytic therapy 18 .…”