Abstract 9901: Double Cardiac Threat of Concomitant Spontaneouscoronary Artery Dissection and Takotsubo Cardiomyopathy

Abstract

Spontaneous Coronary Artery Dissection is an important cause of ACS in females with few atherosclerosis risk factors. SCAD accounts for 25% of ACS cases in women<50 years of age. Takotsubo Cardiomyopathy (TTC) is also a cause of ACS in this group with similar presentation to SCAD. The coexistence of SCAD and TTC has been reported in the literature, emphasizing the importance of an accurate diagnosis. The following case highlights the coexistence of SCAD and TTC and the importance of updated guidelines to identify concomitant TTC and SCAD. Multiparous 41-year-old female, eight days after delivery, was found in cardiac arrest. Patient was intubated, CPR was initiated and after delivery of three shocks, ROSC was achieved. Upon arrival to the hospital, patient underwent TTM. Initial EKG showed no acute ischemic changes and troponin of 27. Patient underwent ECHO EF 40-45% with antero-apical and infero-apical akinesia. On day three, EKG showed ST elevations in leads V2-V6 and following day underwent cardiac catheterization showing an area of dissection in the distal LAD. SCAD and TTC are non-atherosclerotic coronary artery diseases that account for ACS among females. In women <50 years of age, SCAD accounts for 25% of ACS cases. While TTC accounts for 2% of all ACS cases. The diagnosis of SCAD versus TTC could be difficult since both conditions present in similar ways. It is important to recognize that SCAD and TTC can coexist since accurate diagnosis changes treatment. TTC should improve with subsequent echocardiograms. Patients with SCAD should be started on DAPT and identify risk factors such as FMD or aneurysm in other vascular beds. In our patient, the distal LAD is dissected but appears to be a small vessel leading to the antero-apex. However, the distal LAD does not appear to supply the infero-apical area, and the infero-apical hypokinesis is best explained as a component of TTC. Currently, TTC is diagnosed by echo showing transient left ventricular dysfunction and based on clinical presentation, as described by InterTAK diagnostic criteria. However, the InterTAK criteria do not take into account the possible coexistence of TTC and SCAD. Cardiac catheterization should be strongly considered in all cases of TTC to clarify the diagnosis of concomitant TTC and SCAD.