Coronary Intramural Hematoma Presenting as Acute Coronary Syndrome
Takenobu Shimada1, Kazushige Kadota, Shunsuke Kubo
1Department of Cardiology, Kurashiki Central Hospital, Japan.
Insights
A rare case of intramural hematoma in the left anterior descending artery healed without intervention. This finding suggests conservative management may be suitable for select patients with coronary artery hematoma.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Intramural hematoma is a rare cause of acute coronary syndrome.
- Diagnosis often requires advanced imaging like intravascular ultrasound and optical coherence tomography.
Observation:
- A 37-year-old woman presented with chest pain, diagnosed as acute coronary syndrome.
- Coronary angiography revealed significant stenosis with evidence of hematoma on intravascular ultrasound.
- No entry point for the hematoma was identified by optical coherence tomography.
Findings:
- The patient's intramural hematoma, a cause of coronary artery stenosis, resolved spontaneously.
- Conservative treatment was successful due to maintained coronary flow and symptom resolution.
- Follow-up imaging demonstrated significant improvement of the intramural hematoma.
Implications:
- This case highlights the potential for conservative management in spontaneous intramural hematoma.
- It underscores the importance of comprehensive imaging for accurate diagnosis and treatment planning.
- Further research into the natural history and optimal treatment of coronary intramural hematoma is warranted.
Abstract:
We herein report a case of intramural hematoma without ongoing myocardial ischemia that healed spontaneously with conservative treatment. A 37-year-old woman was admitted due to chest pain. Acute coronary syndrome was diagnosed by electrocardiography and echocardiography. Coronary angiography showed 90% stenosis in the distal portion of the left anterior descending coronary artery, where intravascular ultrasound showed a hematoma, but optical coherence tomography could not detect the entry point. Therefore, we identified the intramural hematoma as the etiology. Because the coronary flow was maintained and chest pain disappeared, we chose conservative treatment. Fifteen days after admission, coronary computed tomography showed an improvement in the intramural hematoma.
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