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Spontaneous Coronary Artery Dissection (SCAD) Complicated With Post-Infarction Ventricular Septal Rupture and a
Taha Ahmed1, Olivia Honaker1, Naoki Misumida2
1Department of Internal Medicine, University of Kentucky, Lexington, KY.
Insights
Spontaneous coronary artery dissection (SCAD) can lead to serious heart complications. This case highlights the risk of mechanical complications, like ventricular septal rupture, especially after unsuccessful revascularization in SCAD patients.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) is an under-diagnosed cause of acute coronary syndrome (ACS), primarily affecting younger women without traditional cardiovascular risk factors.
- Mechanical complications following ACS are serious, yet rarely reported in SCAD cases.
Observation:
- A middle-aged woman presented with anterior ST-segment elevation myocardial infarction due to left anterior descending artery SCAD.
- Two revascularization attempts failed, leading to heart failure, reduced ejection fraction, left ventricular pseudoaneurysm, and ventricular septal rupture.
Findings:
- Unsuccessful revascularization in SCAD patients increases the risk of severe post-infarction mechanical complications.
- This case underscores the potential for SCAD to precipitate life-threatening cardiac events requiring surgical intervention.
Implications:
- Clinicians must maintain a high index of suspicion for mechanical complications in SCAD patients, particularly those with high-risk features or failed revascularization.
- Awareness and prompt recognition are crucial for managing SCAD-related mechanical complications and improving patient outcomes.
Abstract:
Spontaneous coronary artery dissection (SCAD) is not uncommon but remains arguably an under-diagnosed etiology for acute coronary syndrome (ACS). It occurs predominantly in young-to-middle aged women who have no or few traditional atherosclerotic cardiovascular disease risk factors. Post-infarction mechanical complications are a dreaded outcome of ACS. However, very few case reports describe these mechanical complications related to SCAD. Unsuccessful revascularization is a particular concern for patients presenting with SCAD-induced ACS, which can increase the risk for certain mechanical complications. We present a case of a middle-aged woman who presented with anterior ST-segment elevation myocardial infarction and was found to have SCAD of left anterior descending coronary artery. Two attempts at revascularization were unsuccessful. Thereafter, her clinical course was complicated by the development of heart failure as a result of a reduced ejection fraction and a left ventricular pseudoaneurysm. Importantly she also suffered a ventricular septal rupture necessitating surgical intervention. Fortunately, our patient had a favorable longer-term outcome. Current literature, including five published case reports on SCAD complicated by mechanical complications are reviewed. Clinicians must remain aware of post-infarction mechanical complications in patients with high-risk and non-revascularized SCAD.
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