Spontaneous Coronary Artery Dissection following Topical Hormone Replacement Therapy.

Alexander L. Pan,Robert Hong,David Fergusson,Ramy A. Badawi

doi:10.1155/2012/524508

Alexander L. Pan, Robert Hong + Show 2 more

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https://doi.org/10.1155/2012/524508

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Abstract

Spontaneous coronary artery dissection is a rare condition, usually presenting as an acute coronary syndrome, and is often seen in states associated with high systemic estrogen levels such as pregnancy or oral contraceptive use. While topical hormonal replacement therapy may result in increased estrogen levels similar to those documented with oral contraceptive use, there are no reported cases of spontaneous coronary dissection with topical hormonal replacement therapy. We describe a 53-year-old female who developed two spontaneous coronary dissections while on topical hormonal replacement therapy. The patient had no other risk factors for coronary dissection. After withdrawal from topical hormonal therapy, our patient has done well and has not had recurrent coronary artery dissections over a one-year follow-up period. The potential contributory role of topical hormonal therapy as a cause of spontaneous coronary dissection should be recognized.

Highlights

Spontaneous coronary artery dissection (SCAD) is a rare condition, usually presenting as an acute coronary syndrome (ACS) in young or middle-aged women, and is often associated with pregnancy or oral contraceptives
While topical hormonal therapy may result in increased estrogen levels similar to those documented with oral contraceptive use, SCAD occurring after topical hormone therapy has not been reported
We report a case of recurrent spontaneous coronary artery dissection in a 53-year-old woman who had been treated with topical hormone replacement therapy for 4 years

Summary

Introduction

Spontaneous coronary artery dissection (SCAD) is a rare condition, usually presenting as an acute coronary syndrome (ACS) in young or middle-aged women, and is often associated with pregnancy or oral contraceptives. While topical hormonal therapy may result in increased estrogen levels similar to those documented with oral contraceptive use, SCAD occurring after topical hormone therapy has not been reported. We report a case of recurrent spontaneous coronary artery dissection in a 53-year-old woman who had been treated with topical hormone replacement therapy for 4 years

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