Challenges in Diagnosis and Management of Spontaneous Coronary Artery Dissection in a Young Patient

TyG index as a predictor of spontaneous coronary artery dissection in young women

OBJECTIVE

Spontaneous coronary artery dissection (SCAD) is a rare but potentially life-threatening pathology and cases are especially seen in women under 50 years of age and with relatively fewer cardiovascular risk factors. Although risk factors facilitating the development of SCAD have been defined in the literature, modifiable risk factors remain unclear. In this study, it was aimed to investigate the relationship between the triglyceride glucose index (TyG) and the development of SCAD in the population of young women.

METHODS

The results of 281 patients were analyzed and compared with each other in terms of clinical, demographic, laboratory parameters, and coronary angiography results.

RESULTS

The mean age was 45 years and all of them were female. When the groups were compared, the TyG and inflammatory parameters were higher in the SCAD group (p < 0.001). When these two groups with low cardiovascular risk factors were compared in logistic regression analysis, high TyG was found to be an independent predictor of SCAD development in young women (p < 0.001).

CONCLUSION

As a result, our study shows that the development of these non-atherosclerotic conditions can be predicted by simple biochemical tests in young women with low atherosclerotic cardiovascular risk factors.

Not Your Common Athletic Heart Problem: Using Coronary CTA to Visualize Spontaneous Coronary Artery Dissection

A 19-year-old healthy male collegiate athlete presented with typical anginal symptoms after running a 5K race. He had complained of similar symptoms off and on for the past month. On presentation, troponin was 0.12 ng/ml (reference value < 0.01 ng/ml), which peaked at 17.7 ng/ml and CK-MB was 28.71 IU/L (reference value < 25 IU/L). ECG showed diffuse biphasic T-waves. Coronary computed tomography angiogram (cCTA) demonstrated a 1.5 cm dissection in the left anterior descending artery and a 1.9 × 1.8 cm attenuation defect in the left ventricular apex consistent with thrombus. Subsequent coronary catheterization confirmed dissection of the left anterior descending artery. Spontaneous coronary artery dissection (SCAD) is a rare phenomenon. Diagnosis can be made through noninvasive measures but is usually done through left heart catheterization. In young patients who present with an NSTEMI, clinical suspicion for SCAD among other conditions should be raised. Additionally, recognizing that complications such as intracardiac thrombi can occur in SCAD is critical in ensuring appropriate therapy.

An Atypical Presentation of Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection is a rare form of acute coronary syndrome (ACS) resulting from tears in the coronary vessel lumen leading to myocardial ischemia. Historically, younger to middle-aged Caucasian females without traditional risk factors for ACS are most commonly affected. The authors present the case of an African American female with numerous traditional ACS risk factors who presented to the emergency department with chest pain. Her workup revealed a stable electrocardiogram despite multiple sets of serially elevating cardiac enzymes and the patient was ultimately diagnosed with a spontaneous coronary artery dissection.