Home
|
Inbox
|
Search
|
View Abstract
Non Atherosclerotic Spontaneous Coronary Artery Dissection a Rare Case of Myocardial Infarction in Young Non Pregnant Female
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A3514 - Non Atherosclerotic Spontaneous Coronary Artery Dissection a Rare Case of Myocardial Infarction in Young Non Pregnant Female
Author Block: F. Aparna, Vikram Taware, Charles Gartman, Sattar, Muhammad,Tahseen, Muhammad.; Internal medicine, crozer chester medical center, Chester, PA, United States.
Introduction
Spontaneous coronary artery dissection (SCAD) is a rare cause of MI. It is associated with 0.1 to 0.4 % cases of MI and almost 25 % cases of myocardial infarction in young female patient under age 50. Fibro-muscular dysplasia, pregnancy, post-partum status, contraceptive use is few of the common predisposing factors.
Case Presentation
The patient is a 38-year-old female with history of PFO and heart murmur since birth, who presented with acute onset severe chest, jaw and right arm pain with shortness of breath. In emergency room EKG suggested acute anterior apical MI and she underwent emergency cardiac catheterization. This showed spontaneous dissection of the mid LAD, spiraling down to the distal part of vessel. The origin of the dissection was stented with improvement in flow, but due to small size and technical difficulty the distal occlusion was left untreated. Patient had partial relief of her symptom, following which patient was managed medically on dual anti-platelets, statin, beta blocker and heparin drip for 48 hours. Patient persisted to have ST elevation in limb lead II, III, aVF and lateral Leads in V4-V6 along with troponin peaking up to 73.69ng/ml. The patient’s symptoms improved after 6-8hour post procedure.
Discussion
SCAD is uncommon cause of acute coronary syndrome, but its prevalence is high in young female patients. The mechanism is not well understood, it is believed that the predilection for women during the peri-partum period is due to increased hemodynamic stresses on the vascular walls, in the presence of hormonal changes that weaken vessel wall integrity. Factors that increase cardiopulmonary stress like severe excursion, emotional stress, labor, cocaine are the predisposing factors. What makes this case interesting is that this patient had idiopathic SCAD and risk factors such as mentioned above are lacking. Almost 80 % of times a single coronary artery is involved and LAD is most commonly affected artery. It is treated with coronary intervention and stenting, but stenting can be technically challenging due to increased risk of entering into false lumen.
Conclusion
The true prevalence of coronary artery dissection still seems unknown, one reason being that these patients have high prevalence of sudden death. SCAD was reported in 0.5% (8 of 1,647) of cases in an autopsy series, although this prevalence could be an underestimate. It should be an important part of differential diagnosis of patient’s presenting with symptoms and EKG findings suggestive of MI in young female.
Author Block: F. Aparna, Vikram Taware, Charles Gartman, Sattar, Muhammad,Tahseen, Muhammad.; Internal medicine, crozer chester medical center, Chester, PA, United States.
Introduction
Spontaneous coronary artery dissection (SCAD) is a rare cause of MI. It is associated with 0.1 to 0.4 % cases of MI and almost 25 % cases of myocardial infarction in young female patient under age 50. Fibro-muscular dysplasia, pregnancy, post-partum status, contraceptive use is few of the common predisposing factors.
Case Presentation
The patient is a 38-year-old female with history of PFO and heart murmur since birth, who presented with acute onset severe chest, jaw and right arm pain with shortness of breath. In emergency room EKG suggested acute anterior apical MI and she underwent emergency cardiac catheterization. This showed spontaneous dissection of the mid LAD, spiraling down to the distal part of vessel. The origin of the dissection was stented with improvement in flow, but due to small size and technical difficulty the distal occlusion was left untreated. Patient had partial relief of her symptom, following which patient was managed medically on dual anti-platelets, statin, beta blocker and heparin drip for 48 hours. Patient persisted to have ST elevation in limb lead II, III, aVF and lateral Leads in V4-V6 along with troponin peaking up to 73.69ng/ml. The patient’s symptoms improved after 6-8hour post procedure.
Discussion
SCAD is uncommon cause of acute coronary syndrome, but its prevalence is high in young female patients. The mechanism is not well understood, it is believed that the predilection for women during the peri-partum period is due to increased hemodynamic stresses on the vascular walls, in the presence of hormonal changes that weaken vessel wall integrity. Factors that increase cardiopulmonary stress like severe excursion, emotional stress, labor, cocaine are the predisposing factors. What makes this case interesting is that this patient had idiopathic SCAD and risk factors such as mentioned above are lacking. Almost 80 % of times a single coronary artery is involved and LAD is most commonly affected artery. It is treated with coronary intervention and stenting, but stenting can be technically challenging due to increased risk of entering into false lumen.
Conclusion
The true prevalence of coronary artery dissection still seems unknown, one reason being that these patients have high prevalence of sudden death. SCAD was reported in 0.5% (8 of 1,647) of cases in an autopsy series, although this prevalence could be an underestimate. It should be an important part of differential diagnosis of patient’s presenting with symptoms and EKG findings suggestive of MI in young female.
|
Home
|
Inbox
|
Search
|