Abstract 12644: Multiple Spontaneous Coronary Artery Dissections in a Middle-Aged Man With Acute Chest Pain

Abstract

Introduction: Previously considered rare, spontaneous coronary artery dissection (SCAD) has emerged as an important cause of chest pain, acute coronary syndrome, and sudden cardiac death. Due to hormonal factors, SCAD often affects seemingly healthy women. SCAD in men remains little understood and under-recognized. We report a case of a 61-year-old gentleman who presented with NSTE-ACS and was found to have SCAD. Patient Presentation: A 61-year-old male with history of untreated hyperlipidemia presented with acute substernal chest pressure radiating to bilateral arms and back. On presentation, vitals and physical examination was normal.His labs showed troponin I at 0.015 ng/mL which later up trended to 21.7 ng/ml. ECG demonstrated sinus bradycardia with no ischemic changes. Decision was made to take him for cardiac catheterization.It demonstrated right coronary artery (RCA) was ecstatic. Distally, there was a a right conus branch fistula draining into pulmonary artery. There was evidence of microvascular dysfunction. An echocardiogram showed mid and basal inferolateral akinesis, normal EF.He was started on dual anti platelets (DAPT) and GDMT. At the time of discharge, he started having recurrence of his chest pain with exertion. Cardiac CT showed multiple spontaneous coronary artery dissections with healing dissections and remodeling throughout the ecstatic RCA and its distal branches with additional contour irregularities and non-obstructive dissection flaps in the diagonal branch of the left anterior dissecting artery. He was enrolled into cardiac rehabilitation. Conclusion: SCAD occurs by the formation of an intramural hematoma or intimal disruption causing a coronary obstruction. Coronary angiography remains the primary tool in the diagnosis. Alternative imaging modalities, such as intravascular ultrasound and optical coherence tomography, CT coronary angiography can be used to confirm the diagnosis. It is managed medically with DAPT and adequate control of blood pressure. Cardiac rehabilitation appears to be beneficial in preventing recurrence. We would also like to emphasize that SCAD can occur in any age group and gender, it’s crucial to recognize it early and is a condition that can be managed conservatively.