Abstract
IntroductionSpontaneous coronary artery dissection is an important yet rare cause of acute coronary syndrome. The available literature shows a higher risk factor for women, notably during pregnancy and puerperium. The incidence in postmenopausal women is exceedingly rare, and is more commonly seen in association with concurrent predisposing factors.We illustrate an extremely rare case of a 62-year-old post-menopausal woman presenting with an acute myocardial infarction secondary to spontaneous dissection of the left anterior descending artery. Subsequent investigations did not reveal the presence of any co-morbidities.To the best of our knowledge, our patient is one of the oldest documented cases of spontaneous coronary artery dissection on record, and is notable for having no known underlying risk factors for development of spontaneous coronary artery dissection.Given the paucity of literature on spontaneous coronary artery dissection, particularly in postmenopausal women, we believe this case will provide further insight into the clinical presentation and management of this rare entity.Case presentationA 62-year-old previously healthy postmenopausal Hispanic woman presented with chest pain and was found to have an ST elevation myocardial infarction. Cardiac catheterization revealed a dissection in her left anterior descending artery. Revascularization was deferred; our patient received appropriate medical management and remained asymptomatic. A full panel of tests was done to exclude underlying connective tissue disorders and vasculitis. On subsequent follow-up, our patient continued to do well and all work-up was reported as negative.ConclusionWe describe the varied presentation and subsequent management of a case of spontaneous coronary artery dissection and highlight the importance of considering spontaneous coronary artery dissection as a differential diagnosis even in older, postmenopausal women.The consequences of a delay in diagnosis and appropriate management are associated with a high mortality and morbidity; hence we believe that reporting all cases of spontaneous coronary artery dissection, particularly in postmenopausal women, will add invaluable information to the limited literature on this rare condition.
Highlights
Spontaneous coronary artery dissection is an important yet rare cause of acute coronary syndrome
We describe the varied presentation and subsequent management of a case of spontaneous coronary artery dissection and highlight the importance of considering spontaneous coronary artery dissection as a differential diagnosis even in older, postmenopausal women
The consequences of a delay in diagnosis and appropriate management are associated with a high mortality and morbidity; we believe that reporting all cases of spontaneous coronary artery dissection, in postmenopausal women, will add invaluable information to the limited literature on this rare condition
Summary
Our case report is not the first of its kind, it does bring forward an extraordinarily uncommon presentation of a rare disease process. Given the rare incidence of SCAD in postmenopausal women, there is a relative dearth of information regarding the clinical presentation, diagnosis and management in postmenopausal women. We hope that this case report and the associated literature review will serve to provide valuable insight into this rare yet intriguing disease process. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
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