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Acute myocardial infarction caused by spontaneous coronary intramural hematoma

Ryutaro Ikegami1, Keiichi Tsuchida, Hirotaka Oda

  • 1Department of Cardiology, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata 950-1197, Japan. ryutaro.i.0820@gmail.com

The Journal of Invasive Cardiology
|December 11, 2012
PubMed

Insights

A rare case of spontaneous coronary artery dissection (SCAD) caused acute myocardial infarction. Treatment with isosorbide dinitrate led to spontaneous resolution of the coronary artery lesion and hematoma.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction, particularly in younger individuals without traditional cardiovascular risk factors.
  • Intramural hematoma formation in the coronary artery can lead to significant stenosis and ischemic events.
  • Distinguishing SCAD from other causes of acute coronary syndrome is crucial for appropriate management.

Observation:

  • A 49-year-old male presented with sudden anterior chest pain and ST-segment elevations, suggestive of acute myocardial infarction.
  • Coronary angiography revealed a long lesion in the right coronary artery (RCA) with severe stenosis.
  • Intravascular ultrasound (IVUS) demonstrated a diffuse intramural hematoma in the RCA without an intimal flap, indicating SCAD.

Findings:

  • Intracoronary isosorbide dinitrate administration resulted in spontaneous regression of the 99% distal RCA stenosis to 50%.
  • No percutaneous coronary intervention (PCI) such as balloon angioplasty or stenting was required.
  • The patient was discharged symptom-free, and follow-up angiography at 30 days showed near-normal RCA findings with complete resolution of the intramural hematoma.

Implications:

  • This case highlights the potential for conservative management in select SCAD cases presenting with acute myocardial infarction.
  • Intravascular ultrasound is valuable in diagnosing SCAD and assessing intramural hematoma resolution.
  • Spontaneous resolution of SCAD-related coronary artery lesions is possible, potentially avoiding invasive procedures.

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