Spontaneous Coronary Artery Rupture Causing Acute Cardiac Tamponade and Cardiogenic Shock

Abstract

Spontaneous coronary artery rupture (SCAR) is an extremely rare, life-threatening entity without any previous underlying diseases. The clinical presentation may differ according to the site of the rupture and some patients may deteriorate early into sudden death due to the abrupt evolution of the associated cardiac tamponade and cardiogenic shock. 1) The correct diagnosis of SCAR deserves a high level of suspicion. It may be confirmed as a differential diagnosis in patients with cardiac tamponade using transthoracic echocardiography (TTE) and computed tomography angiography (CTA) following emergency pericardiocentesis, and a definite diagnosis can be achieved by selective angiography. Although SCAR is associated with a dismal prognosis, some patients have recovered through emergency surgical operations or catheter interventions. 2) We report the case of a patient presenting cardiac tamponade and cardiogenic shock due to spontaneous rupture of the circumflex branch of the left coronary artery, which was successfully isolated by bilateral ligation.(Int Heart J 2019; 60: 1009-1012)

Case Report: Hematoma Formation After Spontaneous Coronary Artery Rupture

“…Sternotomy was performed in all cases reported; the surgical intervention included cardiopulmonary bypass (CPB), hematoma incision, evacuation, pericardial patch, ruptured artery suture or ligation, and CABG. Most of the patients in these cases reported a favorable prognosis except for one death ( 7 ) due to low cardiac output (no myocardial ischemia was found) and acute renal failure after surgery.…”

Sudden Cardiac Arrest Due to Spontaneous Coronary Artery Rupture - A Case Report with a Diagnostic Challenge -

“…The most critical point for the diagnosis is to be highly suspicious of SCAR. A literature search in PubMed identified 16 SCAR cases ( 1 , 2 , 6 - 17 ) ( Table ). The age ranged between 37 to 74 years old, with most in their 50s or 60s.…”

“…If the patient is hemodynamically stable, ECG-gated coronary CTA may be a viable option for detecting coronary rupture and ruling out other causes of pericardial effusion. However, patients in critical conditions who cannot tolerate these examinations need emergent surgery for the diagnosis and treatment ( 1 , 8 , 10 , 12 , 14 , 17 ).…”

Spontaneous coronary artery rupture after lung cancer surgery: A case report and review of literature

“…Consequently, SCAR has limited literature coverage[ 8 , 13 - 22 ]. Only two reports discuss coronary bleeding after pulmonary surgery[ 18 , 22 ]. One case involved a 68-year-old man with left circumflex coronary artery bleeding on postoperative day 4, managed successfully through left thoracotomy[ 22 ].…”

“…One case involved a 68-year-old man with left circumflex coronary artery bleeding on postoperative day 4, managed successfully through left thoracotomy[ 22 ]. The other concerned a 58-year-old man experiencing SCAR 3 mo after surgery; emergency thoracotomy revealed a ruptured left coronary artery ramus branch, and the patient succumbed to it[ 18 ].…”