Spontaneous coronary artery dissection in a female with antiphospholipid syndrome

Area of Science:

• Cardiology
• Rheumatology
• Vascular Medicine

Background:

• Antiphospholipid syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis and pregnancy complications.
• Spontaneous coronary artery dissection (SCAD) is a rare but serious condition involving a tear in the coronary artery wall, often affecting young to middle-aged women.
• The co-occurrence of APS and SCAD is infrequently reported, necessitating further investigation into potential pathomechanisms.

Observation:

• A young female patient with a known diagnosis of antiphospholipid syndrome presented with symptoms suggestive of acute coronary syndrome.
• Coronary angiography demonstrated extensive spontaneous coronary artery dissection involving the left anterior descending (LAD) artery from the proximal to mid segments.
• The patient's clinical presentation and angiographic findings were consistent with SCAD in the context of APS.

Findings:

• The patient was managed conservatively without invasive procedures, focusing on medical management and close monitoring.
• Serial electrocardiograms and cardiac enzyme levels showed improvement, indicating resolution of myocardial ischemia.
• Follow-up coronary angiography performed two months post-presentation revealed complete resolution of the left anterior descending artery dissection, with no residual abnormalities.

Implications:

• This case highlights a potential link between antiphospholipid syndrome and spontaneous coronary artery dissection, suggesting APS as a possible risk factor for SCAD.
• Conservative management appears to be a viable and effective treatment strategy for SCAD in patients with antiphospholipid syndrome, leading to favorable long-term outcomes.
• Further research is warranted to elucidate the underlying mechanisms connecting APS and SCAD and to establish specific clinical guidelines for managing such cases.