Coronary dissection with ST elevation myocardial infarction responding to thrombolytic and conservative therapy alone

Area of Science:

• Cardiology
• Vascular Medicine

Background:

• Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction.
• Management strategies for SCAD, particularly conservative versus invasive approaches, are debated.

Observation:

• A case of SCAD involving the left anterior descending artery presented as acute anterior myocardial infarction.
• The patient refused an initial angiogram, making pre-intervention assessment challenging.

Findings:

• Successful treatment with thrombolytic and conservative therapy was achieved.
• The findings suggest spontaneous thrombus resolution may have occurred before intervention was considered.
• This case implies that SCAD may heal spontaneously and can be managed conservatively in select patients.

Implications:

• Conservative management for SCAD is a viable option in carefully selected cases.
• Individualized treatment decisions are crucial, considering clinical judgment and patient stability.
• Coronary interventions should be reserved for cases unresponsive to conservative therapy or with hemodynamic compromise.