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Spontaneous Coronary Artery Dissection in a Female Patient With Acute Myocardial Infarction

Varinder Bansro1, Mamoon Al-Afun1, Anusha K Battula1

  • 1Internal Medicine, University of Maryland Capital Region Health, Largo, USA.

Cureus
|December 29, 2022
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) can cause heart attacks, especially in young women. Early angiography and specific treatments like antiplatelet therapy are crucial for managing this condition.

Area of Science:

  • Cardiology
  • Vascular Biology

Background:

  • Spontaneous coronary artery dissection (SCAD) is a critical condition characterized by a false lumen within the coronary artery wall.
  • SCAD can lead to acute myocardial infarction (AMI), often presenting similarly to traditional coronary artery disease.

Observation:

  • A case of SCAD presenting as ST-elevation myocardial infarction (STEMI) in a middle-aged woman is discussed.
  • Coronary angiography revealed dissection during left heart catheterization.

Findings:

  • SCAD should be suspected in young females with AMI and no conventional cardiovascular risk factors.
  • Urgent angiography is recommended for suspected SCAD.
  • Optimal management for AMI secondary to SCAD remains unclear, with current strategies based on limited evidence.

Implications:

  • Hemodynamically stable patients may benefit from prompt antiplatelet therapy and beta-blockers.
  • Thrombolytic therapy is contraindicated due to risks of worsening dissection.
  • Coronary artery bypass grafting (CABG) is considered for multi-vessel disease or failed interventions; bioresorbable vascular scaffolds (BVS) may be an alternative in STEMI or instability.

Keywords:
acute myocardial infarctionantiplatelet therapycoronary angiographyfibromuscular dysplasiaspontaneous coronary dissection

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