Spontaneous Coronary Artery Dissection Presenting as Electrical Storm: A Case Report
Nathan Escorial1, Coleman Cowart1, Matthew Paparian1
1Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California.
Insights
Spontaneous coronary artery dissection (SCAD) can cause myocardial infarction and electrical storm (ES) in young adults. Prompt diagnosis and stenting of SCAD led to a patient’s survival with no neurological deficits.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) is a key cause of myocardial infarction in younger individuals lacking traditional atherosclerotic risk factors.
- SCAD can manifest as life-threatening ventricular arrhythmias like ventricular tachycardia (VT) or ventricular fibrillation (VF), collectively termed electrical storm (ES).
Purpose of the Study:
- This report details a case of SCAD presenting as ES in a young, healthy male.
- To highlight the importance of considering SCAD in patients with unexplained cardiac events and ES.
Main Methods:
- A case report of a 38-year-old male experiencing chest pain during exercise, leading to cardiac arrest and ES.
- Diagnosis of SCAD in the left anterior descending artery was confirmed and treated with stenting.
- Patient management included Advanced Cardiac Life Support and defibrillation.
Main Results:
- The patient presented with ES refractory to initial resuscitation efforts.
- Successful stenting of the SCAD lesion was performed.
- The patient recovered neurologically intact after a 13-day hospitalization.
Conclusions:
- Electrical storm is a critical manifestation of SCAD.
- Emergency physicians must maintain a high index of suspicion for SCAD in patients presenting with acute coronary syndrome or ES, especially younger individuals without risk factors.
- Timely diagnosis and intervention for SCAD are crucial for favorable outcomes.
Introduction:
Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in patients of younger age without typical atherosclerotic risk factors and can present with ventricular arrhythmia such as ventricular tachycardia (VT) or ventricular fibrillation (VF). Electrical storm (ES) is defined as greater than or equal to 3 episodes of VT or VF occurring within 24 hours.
Case Report:
A healthy 38-year-old-male developed chest pain while exercising at the gym and presented to the emergency department unresponsive in a ventricular arrhythmia defined as ES. The patient's cardiac arrest was initially refractory to standard defibrillation and Advanced Cardiac Life Support medications. He was ultimately diagnosed with SCAD of the left anterior descending artery, which was stented. The patient survived neurologically intact after a 13-day hospital stay.
Conclusion:
Spontaneous coronary artery dissection is a significant cause of acute coronary syndrome and occurs in healthier patients without cardiac risk factors. Electrical storm represents a unique manifestation of SCAD. Emergency physicians should maintain a heightened suspicion for SCAD for accurate diagnosis and treatment.
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