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A3432 - Spontaneous Coronary Artery Dissection in a Young Female with Fibromuscular Dysplasia
Author Block: A. Thandra1, A. S. Jhand2, A. Smer3, S. Martin4; 1Internal medicine, CHI- creighton university medical center, Omaha, NE, United States, 2Internal Medicine, Creighton University School of Medicine, Omaha, NE, United States, 3Cardiology, CHI- creighton university medical center, omaha, NE, United States, 4School of medicine, CHI- creighton university medical center, Omaha, NE, United States.
Introduction: Spontaneous coronary artery dissection (SCAD) is a rare entity and it has been associated with connective tissue disorders. SCAD has similar presentation to atherosclerotic acute coronary syndrome (ACS). Coronary angiogram is the gold standard diagnostic test. Here in, we discuss a case of young female presented with ACS and found to have SCAD on angiogram.
Case presentation: An otherwise healthy 55-year-old female presents to the emergency department with new onset chest pain. EKG revealed ST segment elevation. Emergent coronary angiogram revealed linear space filling defect in the mid to distal left anterior descending (LAD), consistent with spontaneous dissection. The rest of coronary arteries were normal. Echocardiogram showed akinesia of apex with ejection fraction of 45%. No coronary intervention made and she managed medically. We performed a screening for fibromuscular dysplasia with CT angiogram of abdomen and head and neck. The CT head and neck showed areas of multiple dilatations and narrowing’s of the bilateral mid internal carotid arteries of the neck consistent with fibromuscular dysplasia. The CT angiogram of abdominal aorta and its branches was normal. Hence diagnosed the diagnosis of fibromuscular dysplasia (FMD) without renal involvement was made. The only risk factors she had was use of oral contraceptives and it was discontinued at discharge. After the discharge, the patient was readmitted in a week with another episode of ACS, but no ST-elevation noted. She was medically managed with antiplatelet and antianginal therapy. Discussion: SCAD should be included in the differential diagnosis of young patient with ACS. It is more common in female and usually occurs in the peripartum period or patients with connective tissue disorders, like our patient. Literature review, SCAD is more frequently associated with FMD due to the diminished integrity of the vessel walls and not related to atherosclerosis. On the angiogram, the blood vessels in FMD have classic “string-of-beads” appearance due to alternating fibromuscular and aneurysmal dilatation. In areas of dilatation, the internal elastic lamina is absent, which is possibly the primary defect for the occurrence of coronary dissection. Clinician should consider FMD screening for young female patients with SCAD. Finally, the management of SCAD mainly includes controlling the risk factors and medically treating the patient as coronary artery disease.