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Spontaneous Coronary Artery Dissection Complicated by Left Ventricular Free Wall Rupture in Turner Syndrome

Brendan F Caprio1, Kunal Kotkar2, Alan Zajarias1

  • 1Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.

JACC. Case Reports
|March 2, 2023
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) is a rare cause of heart attack, especially in women with Turner syndrome. This case highlights a unique presentation and successful management of SCAD with left ventricular free wall rupture in a Turner syndrome patient.

Area of Science:

  • Cardiology
  • Genetics
  • Vascular Biology

Background:

  • Turner syndrome is a genetic condition affecting females, associated with cardiovascular risks.
  • Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute myocardial infarction, particularly in young to middle-aged women.
  • Left ventricular free wall rupture is a rare but catastrophic complication of myocardial infarction.

Observation:

  • A 38-year-old female with Turner syndrome presented with acute myocardial infarction.
  • The myocardial infarction was caused by multivessel spontaneous coronary artery dissection (SCAD).
  • The patient developed a left ventricular free wall rupture, characterized as oozing-type.

Findings:

  • Conservative management was initiated for the spontaneous coronary artery dissection (SCAD).
  • The patient successfully underwent sutureless repair for the left ventricular free wall rupture.
  • This represents the first reported case of SCAD in a patient with Turner syndrome.

Implications:

  • This case expands the known spectrum of cardiovascular complications associated with Turner syndrome.
  • It underscores the importance of considering SCAD in young women presenting with myocardial infarction, even with underlying genetic conditions.
  • The successful sutureless repair technique for left ventricular free wall rupture may offer a novel therapeutic option.

Keywords:
ACS, acute coronary syndromeCT, computed tomographyDAPT, dual antiplatelet therapyDKA, diabetic ketoacidosisECG, electrocardiogramLVFWR, left ventricular free wall rupturePCI, percutaneous coronary interventionPEA, pulseless electrical activitySCAD, spontaneous coronary artery dissectionTS, Turner syndromeacute coronary syndromecardiovascular diseasemyocardial infarction

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