Acute myocardial infarction in a patient with primary coronary dissection and severe coronary vasospasm. A case report

Prevalence of Coronary Vasospasm Using Coronary Reactivity Testing in Patients With Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction and sudden cardiac death, particularly in young to middle-aged women. Coronary vasospasm is another condition believed to be associated with SCAD; however, this has only been shown in isolated case reports to date. We sought to examine the association of SCAD and coronary vasospasm by reporting the experience of coronary vasospasm testing in patients with a history of previous SCAD in a large, tertiary referral center. We conducted a single-center retrospective review of patients with history of SCAD confirmed by angiography who received provocative testing using ergonovine in the Cleveland Clinic cardiac catheterization lab from January 1990 to December 2016. Positive vasospasm was defined as: (1) total or subtotal occlusion of at least 1 major coronary artery induced by administration of ergonovine and (2) resolution of said occlusion with the administration of nitrates. Patients with history of strong trauma to the chest and iatrogenic dissection (e.g., catheter-induced) were excluded from the study. We identified 11 patients who satisfied all inclusion criteria. All participants were women and the mean age was 47 years: 73% received screening for fibromuscular dysplasia and of those, 38% were found to have the diagnosis. Only 1 of 11 patients had a positive vasospasm test in the setting of ergonovine administration in the catheterization lab. In conclusion, we found a low prevalence of coronary vasospasm in individuals with confirmed previous SCAD.

Coronary Thrombosis without Dissection following Blunt Trauma

Blunt trauma to the chest resulting in coronary thrombosis and ST elevation myocardial infarction (STEMI) is a rare but well-described occurrence in adults. Angiography in such cases has generally disclosed complete epicardial coronary occlusion with thrombus, indistinguishable from the findings commonly found in spontaneous plaque rupture due to atherosclerotic disease. In all previously reported cases in which coronary interrogation with intravascular ultrasound (IVUS) was performed in association with acute revascularization, coronary artery dissection was implicated as the etiology of coronary thrombosis. We present the first case report of blunt trauma-associated coronary thrombosis without underlying atherosclerosis or coronary dissection, as documented by IVUS imaging.

Sealed with a kick: a case of posttraumatic coronary artery dissection and cardiomyopathy

Blunt chest trauma can lead to a variety of cardiac injuries, one of which is nonatherosclerotic myocardial infarction caused by intimal laceration and thrombotic process activation. Here we present a case of anterior myocardial infarction secondary to blunt trauma involving a kick to the chest.

Acute Anterior Myocardial Infarction after Being Struck on the Chest by a Soccer Ball

Blunt chest wall trauma is one of the non-atherosclerotic causes of myocardial infarction. Motor vehicle accident is the most common cause of myocardial infarction followed by sports injuries. Myocardial infarction can occur due to traumatic coronary artery laceration with thrombus formation or dissection. Lethal complications may result if accompanying myocardial infarction is overlooked in patients whose chest pain is considered to be solely related to the localised blunt chest wall trauma by the physician and the patient. Here we present a case of acute anterior myocardial infarction secondary to a blunt chest trauma after being struck on the chest by a soccer ball during a recreational soccer game and review the current literature on the diagnosis and treatment of traumatic myocardial infarction.

Spontaneous coronary artery dissection of the left circumflex artery causing cardiac tamponade and presenting with atrial fibrillation: a case report and review of the literature

Spontaneous coronary artery dissection is rare. When it does occur, it can present in a myriad of ways and can mimic more common clinical scenarios. Undiagnosed it can be fatal. In this article, the authors present a case of coronary artery dissection in a middle aged man presenting as fast atrial fibrillation with hemodynamic compromise. He was unsuccessfully cardioverted and later arrested and died. Postmortem showed a ruptured dissection of the left circumflex artery causing cardiac tamponade and death. Incidence, associations, pathophysiology, investigations, and treatment options are reviewed.

Spontaneous coronary artery dissection associated with sexual intercourse

We report a case of spontaneous coronary artery dissection associated with sexual intercourse in a 32-year-old, morbidly obese patient. This is the first report of spontaneous coronary artery dissection induced by coital activity and the sixth such report in a male patient.

Spontaneous coronary artery dissection: report of two cases and a 50-year review of the literature

Spontaneous coronary artery dissection (SCAD) is a rare condition that can cause acute myocardial infarction and sudden death. This entity occurs predominantly in women. Although several mechanisms have been postulated, no single etiology completely explains the pathogenesis of SCAD. Patients who survive SCAD have been treated with various modalities. Prompt diagnosis and early institution of appropriate treatment are usually associated with successful outcome. We report two cases of SCAD successfully identified and treated with coronary stenting as well as a comprehensive review of cases of SCAD published since 1952.

A case of acute myocardial infarction due to primary coronary dissection

A case of acute myocardial infarction associated with primary coronary dissection was followed up angiographically. A 46-year-old woman complained of chest oppression. Electrocardiogram on admission showed ST-segment elevation in V1-5. Urgent coronary angiography was performed under a diagnosis of acute anterior myocardial infarction, and showed a significant stenosis with multiple filling defects in segments 7-8 (99% with severe delay) in the left anterior descending artery. There was no organic lesion in the right coronary artery. Intracoronary thrombolytic therapy was unsuccessful, and thereafter she was treated with aspirin, warfarin and isosorbide dinitrate. Coronary angiography performed 1 month later revealed a long dissection with double lumens in segments 7-8. The septal branches emerged from the smaller lumen. Two months later, the 2 lumens were almost equal in size. These findings indicated that coronary dissection produced a false lumen with an entry in segment 7 and a reentry in segment 8, and that the false lumen was responsible for the greater flow. Four months later, the flow in the true lumen had improved remarkably while that in the false lumen had almost disappeared. She remained in stable condition during the follow-up period of 4 months.