Multivessel spontaneous coronary artery dissection involving the left main coronary artery: a case report
Pedro L Cepas-Guillén1, Eduardo J Flores-Umanzor1, Manel Sabate1
1Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clínic, IDIBAPS, University of Barcelona, C/Villarroel, 170, 08036 Barcelona, Spain.
Insights
Spontaneous coronary artery dissection (SCAD) is a rare cause of heart attacks, particularly in young women. Early diagnosis and treatment are crucial for improving outcomes in SCAD patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Diagnostics
Background:
- Spontaneous coronary artery dissection (SCAD) is an infrequent, often misdiagnosed, non-atherosclerotic cause of acute coronary syndrome (ACS).
- SCAD is a significant cause of ACS in women under 50 without traditional cardiovascular risk factors, accounting for up to 25% of cases.
- Clinical presentations vary widely, including ST-segment-elevation myocardial infarction (MI), ventricular fibrillation, and sudden cardiac death.
Observation:
- A 42-year-old woman presented with an anterior ST-segment-elevation MI due to spontaneous dissections of the left main, LAD, and ramus intermedius coronary arteries.
- The patient had no family history of cardiac disease or traditional atherosclerotic risk factors.
- Coronary artery stenting was performed on the left anterior descending and left main arteries; fibromuscular dysplasia was confirmed via CT angiography.
Findings:
- Increased clinical suspicion, earlier invasive angiography, and intracoronary imaging are identifying more SCAD cases.
- The lack of typical cardiovascular risk factors and general unawareness of SCAD can delay diagnosis and treatment.
- Limited prognostic data exist due to underdiagnosis and a scarcity of prospective studies.
Implications:
- Improving the diagnosis and management of SCAD is essential for better patient outcomes.
- Further research and prospective studies are needed to understand SCAD's natural history and optimize treatment strategies.
- Raising awareness among clinicians and the public about SCAD is critical for timely intervention.
Background:
Spontaneous coronary artery dissection (SCAD) is an infrequent and often misdiagnosis of a non-atherosclerotic cause of acute coronary syndrome (ACS). It is an important cause of ACS in young women, responsible for up to 25% of all cases in women <50 years of age without cardiovascular risk factors. Clinical presentation ranges from ST-segment-elevation myocardial infarction (MI) to ventricular fibrillation and sudden death. The treatment of patients with SCAD is a challenge and the ideal management strategy has yet to be determined.
Case Summary:
A 42-year-old woman without family history of cardiac disease and neither traditional atherosclerotic risk factors presented to our centre with an anterior acute ST-segment-elevation MI secondary to multiple spontaneous dissections of the left main, anterior descending, and ramus intermedius coronary arteries. Stenting was performed in the left anterior descending coronary artery and left main coronary artery to resolve its occlusion. Fibromuscular dysplasia was confirmed via computed tomography angiography.
Discussion:
More cases are now being identified of SCAD due to increased clinical index of suspicion, earlier use of invasive angiography, and intracoronary imaging in patients presenting with acute chest pain. Despite this, the absence of previous cardiovascular risk factors and the ignorance of this pathology delay the start of an adequate medical treatment and the performance of a cardiac catheterization. Prognostic data are limited, partly because of its underdiagnosis and lack of prospective studies, so its knowledge is necessary to improve the prognosis of these patients.
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