A rare presentation of primary spontaneous coronary dissection: left ventricular apical thrombus associated with...

Area of Science:

• Cardiology
• Vascular Medicine
• Neurology

Background:

• Primary spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction, typically affecting younger women, often during or after pregnancy.
• SCAD presents with symptoms like unstable angina, myocardial infarction, and heart failure, but its optimal management remains debated.
• Treatment strategies for SCAD vary from conservative medical management to invasive percutaneous or surgical interventions.

Observation:

• A 72-year-old woman presented with an ischemic stroke.
• Imaging revealed a left ventricular apical thrombus as the source of the stroke.
• The thrombus was found to be secondary to primary spontaneous coronary artery dissection.

Findings:

• This case demonstrates a rare presentation of SCAD in an elderly patient.
• SCAD, though uncommon in this age group, can lead to significant embolic events such as ischemic stroke.
• The presence of a left ventricular apical thrombus in this context underscores the potential complications of SCAD.

Implications:

• This case expands the known demographic and clinical spectrum of SCAD.
• It suggests that SCAD should be considered in the differential diagnosis of ischemic stroke, even in older individuals.
• Further research is needed to understand SCAD's occurrence and management in diverse patient populations.