Spontaneous Coronary Artery Dissection: The Phantom Menace

Area of Science:

• Cardiology
• Vascular Medicine

Background:

• Chest pain is a common presentation in emergency departments, often associated with acute coronary syndromes.
• Traditional risk factors and diagnostic markers for myocardial infarction may not be present in all cases of chest pain.

Observation:

• A 66-year-old female presented with chest pain, lacking dynamic electrocardiographic (ECG) changes and showing normal serial troponin levels.
• Coronary angiography identified a linear filling defect in the first obtuse marginal branch of the circumflex artery, indicative of coronary artery dissection with superimposed thrombus.

Findings:

• The case highlights Spontaneous Coronary Artery Dissection (SCAD) as a potential cause of cardiac chest pain that can be overlooked.
• Medical management, including dual antiplatelet therapy, proved effective for this SCAD patient, leading to a favorable outcome.
• SCAD management differs from other acute coronary syndromes; conservative treatment is generally superior to invasive intervention unless hemodynamic compromise occurs.

Implications:

• Coronary angiography is crucial for diagnosing SCAD, especially in patients with unexplained chest pain and non-diagnostic initial evaluations.
• Conservative medical management should be considered the primary treatment strategy for SCAD in the absence of hemodynamic instability.
• This case underscores the importance of considering rare etiologies like SCAD in the differential diagnosis of acute chest pain.