Rare case of asymptomatic spontaneous coronary artery dissection
Arsalan Rafiq1, Parash Pokharel2, Nassim R Krim3
1Mount Sinai St. Luke's Hospital-Bronx Lebanon Hospital Center, New York, NY, USA.
Insights
A syncopal episode in a 46-year-old woman revealed spontaneous coronary artery dissection (SCAD). The case highlights the need to consider SCAD in acute coronary syndrome (ACS) evaluations, especially in young women.
Area of Science:
- Cardiology
- Vascular Medicine
- Infectious Disease
Background:
- Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), particularly in young adults.
- SCAD can present with diverse symptoms including syncope, chest pain, ventricular arrhythmias, and sudden cardiac death.
- The etiology of SCAD remains incompletely understood, with potential links to various underlying conditions.
Purpose of the Study:
- To report a unique case of SCAD presenting with syncope in a middle-aged woman.
- To explore a potential association between SCAD and prior syphilis infection.
- To emphasize the importance of considering SCAD in the differential diagnosis of ACS in young patients, especially females.
Main Methods:
- Case presentation of a 46-year-old woman with syncope.
- Diagnostic workup including transthoracic echocardiogram and cardiac evaluation.
- Serological testing for syphilis (Rapid Plasma Reagin).
Main Results:
- Transthoracic echocardiogram revealed new-onset left ventricular dysfunction.
- Cardiac evaluation identified chronic coronary artery dissection in the proximal left anterior descending artery.
- Syncope was attributed to a vasovagal event, but a positive Rapid Plasma Reagin test raised suspicion for vasculitic manifestation of prior syphilis.
Conclusions:
- This case underscores the importance of considering SCAD in the differential diagnosis of ACS, particularly in young women.
- The positive syphilis test prompts further investigation into a potential link between vasculitis secondary to syphilis and SCAD.
- Further research is crucial to elucidate the association between syphilis and SCAD and to establish consensus guidelines for SCAD management.
Abstract:
We present a case of a 46-year-old woman who presented to the emergency room after a syncopal episode. Most of her initial workup did not lead to any diagnosis. However, the transthoracic echocardiogram showed new onset left ventricular dysfunction. Further, cardiac evaluation showed a chronic coronary artery dissection in the proximal left anterior descending artery. Syncope was related to vasovagal event but rapid plasma reagin being positive led to the question of whether the coronary artery dissection was secondary to vasculitic manifestation of prior syphilis infection. More research is needed to answer this question and to find such an association. <Learning objective: Spontaneous coronary artery dissection (SCAD) is a rare disease of young adults that can present acutely as an acute coronary syndrome (ACS) with chest pain, as malignant ventricular arrhythmia, and even as sudden cardiac death. Our report is focused on evaluation and management of SCAD, more importantly to consider SCAD as a differential diagnosis in ACS in young patients, especially females. Our review also stresses the need for further research toward development of consensus on management of such patients.>.
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