Causa rara de parada cardíaca: um caso de extensa dissecção espontânea da artéria coronária esquerda

Cátia Oliveira,João Costa,Sérgia Rocha,Jorge Marques,Carlos Braga

doi:10.31160/jotci202230a20210036

Abstract

A 28-year-old male with a previous history of drug abuse was sent to an emergent coronary angiography, after a cardiac arrest, with a post-resuscitation eletrocardiogram showing ST-segment elevation from V1-V4. Angiography showed multivessel and multisegment spontaneous coronary artery dissection. Due to clinical instability, patient underwent left anterior descending artery percutaneous coronary intervention. Prevalence of spontaneous coronary artery dissection as the cause of acute coronary syndrome is anecdotal in men. Yet, in the right scenarios as in this case, it must be ruled out. Cardiorespiratory arrest is an uncommon presentation of spontaneous coronary artery dissection and percutaneous coronary intervention in spontaneous coronary artery dissection is still a matter of debate.

Highlights

Acute myocardial infarction (MI) due to spontaneous coronary artery dissection (SCAD), previously considered as a rare entity associated to pregnancy, is nowadays recognized as a multifactorial disease with increasing prevalence
The mechanism of cocaine toxicity on the heart and vasculature is predominantly related to its adrenergic properties, with increased blood pressure due to inotropic and chronotropic effects, as well as its vasoconstrictive effect leading to an increase of the shear forces on the coronary endothelium
Other hypothesis related to drug abuse is vasospasm, which seemed less probable in this case since the lesions did not improve after intracoronary administration of nitrates, and the angiographic evolution of the multivessel disease was very suggestive of SCAD

Summary

CASE REPORT

Causa rara de parada cardíaca: um caso de extensa dissecção espontânea da artéria coronária esquerda. A rare cause of cardiac arrest: a case of an extensive left coronary artery spontaneous dissection. Angiography showed multivessel and multisegment spontaneous coronary artery dissection. A angiografia mostrou dissecção espontânea da artéria coronária, multiarterial e em diversos segmentos. A prevalência da dissecção espontânea da artéria coronária como causa de síndrome coronariana aguda em homens é infrequente. A parada cardiorrespiratória é um quadro incomum na dissecção espontânea da artéria coronária, e a intervenção coronária percutânea como modalidade terapêutica ainda é uma questão em debate. Descritores: Dissecção espontânea da artéria coronária; Infarto do miocárdio; Parada cardíaca; Transtornos relacionados ao uso de substâncias; Angiografia coronária; Doenças vasculares

INTRODUCTION

Findings

DISCUSSION