Abstract
Spontaneous coronary artery dissection (SCAD) is a non-traumatic, non-iatrogenic, and non-atherosclerotic coronary artery disorder that manifests clinically as acute coronary syndrome (ACS), arrhythmia, or sudden cardiac death (SCD). It is a rare cause of ACS (1.7%-4%) and SCD (0.5%), more common in women than men. It was first reported in 1931 in a 42-year-old female at autopsy, who had SCAD after violent retching and vomiting. We report a case of a 51-year-old female who developed sudden-onset chest pain after taking topiramate (TPM). Her chest pain persisted for 1.5 months prior to her outpatient evaluation, which led to further cardiac workup. An urgent left heart catheterization (LHC) revealed a SCAD. Her symptoms improved with percutaneous coronary intervention (PCI), and she was discharged home on aspirin, statins, and beta-blockers.
Highlights
We report a case of a 51-year-old female who developed sudden-onset chest pain after taking topiramate (TPM)
Her chest pain persisted for 1.5 months prior to her outpatient evaluation, which led to further cardiac workup
Spontaneous coronary artery dissection (SCAD) is a non-obstructive coronary artery disease clinically representing as acute coronary syndrome (ACS), arrhythmia, or sudden cardiac death (SCD)
Summary
Spontaneous coronary artery dissection (SCAD) is a non-obstructive coronary artery disease clinically representing as acute coronary syndrome (ACS), arrhythmia, or sudden cardiac death (SCD). Her chest pain occurred on a daily basis including waking her up in the morning from severe pain She has known gastroesophageal reflux disease (GERD) and called her gastroenterologist but was subsequently referred to the cardiologist’s office to rule out acute coronary syndrome (ACS). The cardiologist sent her to the emergency room (ER) due to the history of resting chest pain and abnormal electrocardiogram (ECG). ECG upon presentation to the ER showed mild ST-segment depression at II, III, aVF, and V3-V6 Given her recurrent chest pain, EKG with ST depressions in the anterior leads and premature surgical menopause, a decision was made to go for left heart catheterization (LHC) after beginning aspirin and metoprolol. The patient was continued on aspirin 81 mg daily, metoprolol 12.5 mg twice a day, and was placed on ticagrelor 90 mg twice a day and rosuvastatin 10 mg daily
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