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Spontaneous coronary artery dissection in a patient with systemic lupus erythematosis

Arvind K Sharma1, Andrew Farb, Parimal Maniar

  • 1Division of Cardiology, Washington Hospital Center, USA arvshar@aol.com

Hawaii Medical Journal
|January 2, 2004
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) is rare but can cause fatal heart attacks, particularly in women. This case highlights SCAD in a patient with systemic lupus erythematosus (SLE), emphasizing diagnostic considerations.

Area of Science:

  • Cardiology
  • Rheumatology
  • Pathology

Background:

  • Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction, typically affecting younger to middle-aged women.
  • Systemic lupus erythematosus (SLE) is an autoimmune disease with various cardiovascular manifestations, but coronary dissection is not a commonly reported association.

Observation:

  • A 48-year-old woman with a history of SLE experienced a fatal spontaneous left main coronary artery dissection.
  • Coronary angiography revealed significant, cyclical variations in coronary lumen diameter between systole and diastole.

Findings:

  • This case represents the first reported instance of coronary artery dissection in a patient with SLE.
  • The unique angiographic findings of phasic lumen changes suggest SCAD, even without classic dissection signs.

Implications:

  • Clinicians should consider SCAD in the differential diagnosis of chest pain and myocardial infarction in SLE patients.
  • Detailed analysis of dynamic changes in coronary artery dimensions during the cardiac cycle may aid in diagnosing SCAD, especially when typical angiographic features are absent.

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