Survival with acute primary coronary artery dissection: A case report and review of the literature

Spontaneous coronary artery dissection: a report of two atypical cases

Spontaneous coronary artery dissection is a rare pathology that has no exact incidence, etiology, pathogenesis and evolution in literature. We report two cases of two women with coronary artery dissection, uncommon clinical presentation of acute coronary syndrome and without identifiable risk factors. A review of the literature and the management of this condition are presented.

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial ischemia with complex pathophysiology. This paper reviews the major diagnostic and therapeutic issues of this rare but important disease. The diagnosis of SCAD should be strongly considered in any patient who presents with symptoms suggestive of acute myocardial ischemia, particularly in young subjects without traditional risk factors for coronary artery disease (especially in young women during the peripartum period or in association with oral contraceptive use). Urgent coronary angiography is indicated to establish the diagnosis and to determine the appropriate therapeutic approach. The decision to pursue medical management, percutaneous coronary intervention, or surgical revascularization is based primarily on the clinical presentation, extent of dissection, and amount of ischemic myocardium at risk.

Double vessel extension of spontaneous left main coronary artery dissection in young women treated with thrombolytics

Spontaneous coronary artery dissection is an extremely rare cause of myocardial infarction. The prognosis and treatment of coronary artery dissection have not yet been defined. We report on a 42-year-old woman who was admitted to the emergency unit of a regional hospital with central chest pain and electrocardiographic signs of extensive acute anterior myocardial infarction (MI). She was treated with thrombolytics, yet her condition deteriorated rapidly, resulting in cardiogenic shock. An angiogram revealed dissection of the left main coronary artery that extended into the anterior descending (LAD) and circumflex arteries (LCX). At autopsy a recent anterolateral MI of the left ventricle was found. Dissection of the left coronary artery system was confirmed. Extension of the dissection may have been due to thrombolytic treatment.

Spontaneous multivessel coronary artery dissection: repeated presentation in a healthy postmenopausal woman

Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction which is infrequently diagnosed antemortem. Most previously reported cases were found in women of whom a significant proportion presented during pregnancy or the postpartum period. We describe the first antemortem case of spontaneous coronary artery dissection, unrelated to pregnancy or the postpartum state, which ultimately resulted in diffuse involvement of both the left and right coronary arteries over a period of 4 months. Pathophysiology and case management of this disorder are discussed.

Spontaneous coronary artery dissection. Case report and literature review

Primary coronary artery dissection occurring 2 months post partum in a 33-year-old woman is described. Owing to suspected acute myocardial infarction, the patient was treated with thrombolytic therapy but her condition deteriorated. Coronary angiography showed dissection of the left anterior descending artery (LAD). Her condition stabilized during treatment with intravenous heparin, aspirin, nitrates, beta-blockers, digoxin, ACE inhibitor and anticoagulants. At discharge she had no symptoms of heart failure. One hundred and forty one cases from the literature are reviewed with special reference to patient characteristics, patient treatment, and prognosis. Primary spontaneous coronary artery dissection is a rare condition but one that must be considered when young people, especially post partum women, present an acute ischaemic syndrome. Thrombolytic therapy may be a two-edged sword and therefore early angiography should be considered in making the diagnosis and choosing the therapy.

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection is a rare coronary pathology whose precise incidence, etiology, pathogenesis, treatment and evolution have not been clearly established. Sudden death accounts for the majority of presentations. It occurs most commonly in young women in the left anterior descending coronary artery. We report the case of a 48-year-old male with asymptomatic spontaneous dissection in the anterior descending coronary artery.

Postpartum coronary artery dissection

A 34-year-old woman presented to the emergency department 12 weeks postpartum with chest pain. An ECG indicated an acute myocardial infarction. The patient underwent cardiac catheterization with findings suggestive of coronary artery dissection later confirmed on intravascular ultrasonography. She underwent emergency coronary artery bypass grafting and has subsequently done well.