Spontaneous Occlusion of the Sinus Node Artery: A Case Report

Abstract

Introduction: Occlusion of the sinus node artery is a rare situation. It is responsible for sinus node dysfunction and often occurs accidentally during percutaneous coronary intervention of a proximal lesion of the right coronary artery Case Report: This is a sixty-year-old woman with high blood pressure treat by dual therapy (an enzyme conversion inhibitor and a thiazide diuretic), who presented to the cardiological emergency room for a typical angina pain that had been evolving for 48 hours without a lull. Her clinical examination was normal apart from grade 3 arterial hypertension. The 18-lead surface electrocardiogram showed an electrical left ventricular hypertrophy with undershift of the ST segment in lateral and posterior territories, with an overshift of the ST segment in the antero-septal without any sign of necrosis. Biologically, the ultra-sensitive troponinemia was 88 times normal. The diagnosis of NSTEMI with troponin was retained with an intermediate ischaemic risk. Transthoracic Doppler echocardiography showed concentric hypertrophy of the left ventricular walls and dyskinesia of the right ventricle infero-apical wall. The coronary angiography showed an occlusion of the sinus node artery and a left coronary artery atheromatous with an intermediate lesion in the middle segment of the anterior interventricular artery. Conclusion: The present clinical case highlights the diversity in the expression of a sinus node artery occlusion that can occur spontaneously outside of a percutaneous coronary intervention.