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Spontaneous coronary artery dissection after a natural course for 10 years--a case report
J Osaki1, K Hirasawa, K Tateda
1Department of Internal Medicine, Asahikawa Municipal Hospital, Japan.
Insights
Spontaneous coronary artery dissection (SCAD) with myocardial infarction may have a better prognosis than previously thought. Coronary spasm involvement suggests effective treatment with nitrates or calcium antagonists for an uneventful recovery.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Spontaneous Coronary Artery Dissection (SCAD) is a rare but serious condition.
- Acute myocardial infarction (MI) can be a complication of SCAD.
- Long-term outcomes and management strategies for SCAD remain areas of active investigation.
Observation:
- A 58-year-old male presented with acute inferior myocardial infarction.
- Coronary angiography revealed a double lumen in the right coronary artery, indicative of SCAD, without occlusion.
- Follow-up angiography 10 years later showed persistent dissection, with induced coronary spasm during acetylcholine infusion.
Findings:
- The patient's SCAD remained stable over a decade without recurrent infarction.
- Coronary artery spasm was identified as a potential contributing factor in the development of SCAD and MI.
- Treatment with nitrates appeared effective in managing the condition.
Implications:
- SCAD complicated by MI may have a more favorable prognosis than traditionally assumed.
- Identifying and managing coronary spasm is crucial for patients with SCAD.
- Pharmacological interventions, such as nitrates and calcium antagonists, may lead to favorable long-term outcomes in SCAD patients.
Abstract:
We encountered a patient with spontaneous coronary artery dissection complicated by acute inferior myocardial infarction. A 58-year-old male was admitted to our hospital due to acute inferior myocardial infarction in 1979. Coronary angiography performed 4 weeks after the onset showed a double lumen divided by a linear intimal flap in the right coronary artery, suggesting coronary artery dissection, but no apparent occlusion. Subsequently, he had been medicated with nitrates without any recurrent infarction. In February, 1989, 10 years after the first examination, coronary angiography was again performed and showed that the dissection had remained unchanged. Acetylcholine infusion into the right coronary artery induced coronary spasm. The prognosis of this condition seems to be better than has been generally considered, particularly in patients such as ours in whom the involvement of coronary spasm in the development of coronary artery dissection and myocardial infarction is suggested. When coronary spasm in controlled by treatment with nitrates or calcium antagonists, an uneventful course may be expected.