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A Non-atherosclerotic Heart Tears Apart: A Case of Spontaneous Coronary Artery Dissection in a Healthy Postmenopausal Woman



Case Reports

. 2022 May 29;14(5):e25459.


doi: 10.7759/cureus.25459.


eCollection 2022 May.

Affiliations

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Case Reports

Vishal Phogat et al.


Cureus.


.

Abstract

Due to limited understanding and knowledge of spontaneous coronary artery dissection (SCAD), it is typically believed to affect young peripartum women. We present a case of a post-menopausal older woman who suffered an acute non-ST segment elevation myocardial infarction (NSTEMI), secondary to a SCAD of the right posterior descending artery (PDA), after strenuous exercise. As the patient was hemodynamically stable and without signs of ongoing ischemia, she was managed conservatively. SCAD should be in differentials for patients presenting with acute coronary syndrome (ACS) who have no or few cardiovascular atherosclerotic risk factors. SCAD can be missed due to low suspicion of ACS in young and healthy patients. ACS from SCAD is often misdiagnosed and/or mismanaged as atherosclerotic ACS. Increasing awareness about this condition can lead to earlier diagnosis and prevention of sudden cardiac deaths. As most cases of SCAD can be managed conservatively, differentiating it from atherosclerotic ACS can reduce unnecessary reperfusion procedures and complications thereof.


Keywords:

cardiac death; nste-acs; post partum acs; scad management; scad types; spontaneous coronary dissection; sudden cardiac.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures



Figure 1. Electrocardiogram showing a normal sinus rhythm

Normal sinus rhythm with a ventricular rate of 66 beats per minute was seen on an electrocardiogram. No acute ST segment or T wave changes were noticed.


Figure 2


Figure 2. Coronary angiogram LAO view showing a right posterior descending artery spontaneous coronary artery dissection

Right coronary angiogram LAO view shows smooth and diffuse stenosis and string-like appearance of the right posterior descending artery (pointed with two arrows), suggestive of type 2 spontaneous coronary artery dissection. LAO – left anterior oblique

References

    1. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Hayes SN, Kim ES, Saw J, et al. Circulation. 2018;137:523–557.



      PMC



      PubMed

    1. Revascularization in patients with spontaneous coronary artery dissection and ST-segment elevation myocardial infarction. Lobo AS, Cantu SM, Sharkey SW, et al. J Am Coll Cardiol. 2019;74:1290–1300.



      PubMed

    1. Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome. Nishiguchi T, Tanaka A, Ozaki Y, et al. Eur Heart J Acute Cardiovasc Care. 2016;5:263–270.



      PubMed

    1. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Elkayam U, Jalnapurkar S, Barakkat MN, Khatri N, Kealey AJ, Mehra A, Roth A. Circulation. 2014;129:1695–1702.



      PubMed

    1. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. Saw J, Starovoytov A, Humphries K, et al. Eur Heart J. 2019;40:1188–1197.



      PMC



      PubMed



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