ST-Elevation Myocardial Infarction from Spontaneous Coronary Artery Dissection
Pallavi Lakra1,2, Shiavax J Rao1,2, Abhinandan R Chittal1,2
1Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA.
Summary
Spontaneous coronary artery dissection (SCAD) is a rare condition causing non-traumatic arterial wall separation. This case highlights SCAD presenting as ST-elevation myocardial infarction (STEMI) in a woman with prior infection, emphasizing prompt diagnosis and management.
Area of Science:
- Cardiology
- Vascular Biology
Background:
- Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic condition leading to coronary artery wall separation, predominantly affecting women.
- The underlying mechanisms of SCAD remain unclear, necessitating further research into its etiology and risk factors.
Observation:
- A 54-year-old woman presented with symptoms of infection, complicated by septic shock, renal failure, and respiratory failure.
- Following recovery from critical illness, she developed acute chest pain and was diagnosed with ST-elevation myocardial infarction (STEMI).
Findings:
- Cardiac catheterization revealed SCAD of the right posterior descending artery (RPDA).
- Due to vessel tortuosity, the patient was managed medically with dual antiplatelet therapy, beta-blockers, and an eptifibatide infusion, showing hemodynamic stability post-procedure.
Implications:
- This case underscores the importance of considering SCAD in patients presenting with myocardial infarction, even with atypical histories.
- Prompt recognition and tailored medical management are crucial for favorable outcomes in SCAD, particularly when percutaneous coronary intervention is not feasible.
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