Chronic spontaneous coronary artery dissection in association with antiphospholipid syndrome presenting as stable...

Area of Science:

• Cardiology
• Vascular Medicine
• Rheumatology

Background:

• Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disorder associated with an increased risk of arterial and venous thrombosis.
• Coronary artery dissection is a rare but serious complication of APS, often presenting with symptoms mimicking atherosclerotic coronary artery disease.
• This case highlights the importance of considering APS in patients with unexplained thrombotic events and cardiovascular symptoms.

Observation:

• A 52-year-old man with a history of APS and three prior thrombotic events presented with stable angina for risk stratification.
• Coronary angiography revealed a spontaneous chronic dissection of the dominant right coronary artery with TIMI III flow, rather than typical atherosclerotic disease.
• The patient had no evidence of acute myocardial infarction or significant obstructive coronary artery disease.

Findings:

• Medical management with antianginal therapy resulted in complete resolution of angina symptoms.
• The patient remained asymptomatic with regular cardiology follow-up.
• This suggests that spontaneous coronary artery dissection in the context of APS can be managed conservatively with medical therapy.

Implications:

• This case underscores the diverse cardiovascular manifestations of APS beyond traditional thrombotic events.
• It emphasizes the need for a high index of suspicion for non-atherosclerotic coronary artery pathology in APS patients.
• Conservative medical management may be a viable strategy for spontaneous coronary artery dissection in APS, avoiding invasive procedures.