Spontaneous coronary artery dissection: an uncommon primary presenting feature of fibromuscular dysplasia

Area of Science:

• Cardiology
• Vascular Medicine
• Radiology

Background:

• Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome (ACS), particularly in young women.
• SCAD accounts for a significant percentage of ACS cases in premenopausal women.
• It is often an underdiagnosed condition, and its association with fibromuscular dysplasia (FMD) is increasingly recognized.

Observation:

• A woman in her 40s with no prior significant medical history presented with an anterior ST-elevation myocardial infarction.
• Invasive coronary angiography revealed spontaneous coronary artery dissection as the cause of the myocardial infarction.
• Subsequent MR angiography confirmed an underlying diagnosis of fibromuscular dysplasia.

Findings:

• The case demonstrates a direct link between spontaneous coronary artery dissection and fibromuscular dysplasia.
• SCAD can present as an ST-elevation myocardial infarction, mimicking other common cardiac emergencies.
• Fibromuscular dysplasia should be considered in the etiological workup of SCAD, especially in younger patients.

Implications:

• This case underscores the importance of considering SCAD in young women presenting with acute coronary syndrome.
• Early diagnosis of SCAD and identification of underlying conditions like FMD are crucial for appropriate management.
• Increased awareness and diagnostic vigilance for SCAD and FMD can improve patient outcomes and prevent recurrent events.