The Self Sabotaging Vessel: A Case Report and Literature Review of Spontaneous Coronary Artery Dissection.

Esiemoghie J Akhigbe,Ebubechukwu Ezeh,Melissa Lester,Kanaan Mansoor,Jason Mader,Paul I Okhumale

doi:10.7759/cureus.20835

Abstract

Spontaneous coronary artery dissection (SCAD) is a very rare cause of acute coronary syndrome. Despite the recent advances in the management of cardiovascular diseases, the diagnoses and management of SCAD remain a dilemma. It has been described to majorly affect females of childbearing age, immediately post-partum or on oral contraceptives. Recent cases have also identified underlying connective tissue disease as a risk factor. Since its discovery, only a limited number of cases affecting males have been reported in the literature. This makes our case unique. In this, we present a 31-year-old male without any traditional risk factors who presented with atypical chest pain. Electrocardiogram showed ST-segment changes with echocardiogram revealing apical left ventricular akinesis. A diagnostic left heart catheterization showed multiple lumens in the distal left anterior descending artery (LAD). The patient was managed conservatively and discharged home on guideline-directed medical therapy.

Highlights

BackgroundSpontaneous coronary artery dissection (SCAD) is an important non-atherosclerotic, non-traumatic, noniatrogenic etiology underlying acute coronary syndromes (ACS) or sudden cardiac death [1]
Women with SCAD frequently present at a younger age and usually during the peripartum period or in association with oral contraceptive use with involvement of the left anterior descending (LAD) artery and/or left main coronary artery (LMCA), and SCAD usually occurs in the absence of traditional risk factors for coronary artery disease
SCAD frequently presents at a slightly later age, usually involves the right coronary artery (RCA), patients typically have clinical evidence of coronary artery disease (CAD) or risk factors for atherosclerosis [5]. This case illustrates an unusual presentation of SCAD in a young male with emphasis on the diagnosis, presentation, and management of this rare etiology of ACS

Summary

Introduction

Spontaneous coronary artery dissection (SCAD) is an important non-atherosclerotic, non-traumatic, noniatrogenic etiology underlying acute coronary syndromes (ACS) or sudden cardiac death [1]. SCAD frequently presents at a slightly later age (mean age of 46), usually involves the right coronary artery (RCA), patients typically have clinical evidence of coronary artery disease (CAD) or risk factors for atherosclerosis [5]. This case illustrates an unusual presentation of SCAD in a young male with emphasis on the diagnosis, presentation, and management of this rare etiology of ACS. Type 2 angiographic SCAD describes a long diffuse (typically >20 mm) stenosis that varies in severity from mild to complete occlusion This appearance commonly involves the mid-segment and often extends to the distal segment and tip of the arteries with dissection and/or wall hematoma formation producing smooth coronary artery narrowing. After the acute phase, estimated survival is good, at about 70% to 90% [25]

Conclusions

Disclosures

Findings

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