Young woman with cardiac arrest due to spontaneous coronary artery dissection.
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ABSTRACT:
SUBMITTER: Cimci M
PROVIDER: S-EPMC7141438 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
Publications
Young woman with cardiac arrest due to spontaneous coronary artery dissection.
Çimci Murat M Sologashvili Tornike T Yilmaz Nurcan N Frangos Caroline C Roffi Marco M
Anatolian journal of cardiology 20200101 1
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Project description:We present two cases of spontaneous coronary artery dissection (SCAD). Both examples encourage a broad differential and open mind for chest pain in a young woman. We also highlight a case of SCAD where the patient presented following ventricular fibrillation arrest, a less common though potentially fatal consequence of SCAD.
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Project description:Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal. We report the case of a 70-year-old woman who presented with an acute ST-segment-elevation myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. She was treated conservatively. Cardiac tamponade developed 16 hours after presentation. Repeat coronary angiography revealed extension of the dissection. Medical therapy was continued after the hemopericardium was aspirated. The patient remained asymptomatic 3 years after hospital discharge. To our knowledge, this is the first reported case of spontaneous coronary artery dissection in association with cardiac tamponade that was treated conservatively and had a successful outcome.
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Project description:BackgroundCoronary artery spasm (CAS) is a pathological condition resulting from transient functional narrowing of the coronary arteries leading to myocardial ischaemia and in some rare cases even to sudden cardiac arrest (SCA). The most important preventable risk factor is use of tobacco, whereas possible precipitating factors include some medications and psychological stress.Case summaryA 32-year-old woman was hospitalized with burning chest pain. The immediate investigations revealed the diagnosis of non-ST-segment elevation myocardial infarction, because of ST elevations in one single lead and increased high-sensitivity troponin. Due to ongoing chest pain and a severe impaired left ventricular ejection fraction (LVEF) of 30% with apical akinesia, a prompt coronary angiography (CAG) was scheduled. After aspirin administration, she developed anaphylaxis with pulseless electrical activity (PEA). She could be resuscitated successfully. CAG revealed multi-vessel CAS for which she received calcium channel blockers. Five days after, she suffered from a second SCA due to ventricular fibrillation and was resuscitated again. Repeated CAG showed no critical coronary artery occlusion. LVEF improved progressively during hospitalization. Drug therapy was increased, and a subcutaneous implantable cardioverter defibrillator (ICD) was implanted for secondary prevention.DiscussionCAS may in some instances lead to SCA, especially in case of multi-vessel involvement. Allergic and anaphylactic events can trigger CAS, which are frequently underestimated. Regardless of the cause, cornerstone of CAS prophylaxes remains optimal medical therapy as in the avoidance of predisposing risk factors. In case of life-threatening arrhythmia, the implantation of an ICD should be considered.
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Project description:Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial ischemia commonly seen in younger patients, particularly women. Patients often present similar to those with acute coronary syndrome (ACS); however, they often are missing the classic risk factors that are typically associated with coronary artery disease. Differentiating between SCAD and ACS is vital as they are managed differently with up to 80% of SCAD being managed conservatively. We present a case of 61-year-old woman with no previous cardiac history presenting with chest pain and was found to have spontaneous coronary artery dissection on coronary angiography.
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Project description:Spontaneous coronary artery dissection is a rare condition that can precipitate acute coronary syndrome in pregnant and peripartum women. A 32-year-old previously healthy female, 2-weeks post-partum, presented to the emergency department after sudden cardiac arrest. Return of spontaneous circulation was achieved after multiple rounds of resuscitation. Electrocardiogram revealed ST elevations in the anterolateral leads with reciprocal changes. She was taken to the catheterization lab by cardiology and was found to have a dissection of the distal left anterior descending coronary artery. The patient was subsequently treated medically with heparin and antiplatelet therapy, but ultimately died of anoxic encephalopathy. The purpose of this report is to describe the risk factors, presentation, and management of spontaneous coronary artery dissection which can be easily overlooked given its rarity.TopicsSpontaneous coronary artery dissection, out-of-hospital cardiac arrest, peri-partum complications.
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Project description:Spontaneous coronary artery dissection is a nontraumatic, noniatrogenic intimal tearing of the coronary artery in patients without atherosclerotic coronary disease. We present 3 unique cases of patients with spontaneous coronary artery dissection and atherosclerotic coronary artery disease. (Level of Difficulty: Intermediate.).
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Project description:Spontaneous coronary artery dissection (SCAD) is one of the rare causes of acute coronary syndrome in young healthy individuals especially women without having any conventional risk factors for coronary artery disease. We describe a case of 34-year-old healthy man with diffuse multiple SCADs who presented with acute coronary syndrome and was managed conservatively with an uneventful course on long-term follow-up.
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