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Uncovering a hidden danger: a case report of diffuse coronary spasm concealing spontaneous coronary artery dissection
Paolo Desario1, David Rutigliano2, Vincenzo Palumbo2
1Cardiology Department, San Paolo Hospital, Via Caposcardicchio sn, 70132, Bari, Italy. paolo.desario91@gmail.com.
Insights
Spontaneous coronary artery dissection (SCAD) and coronary artery spasm (CAS) can mimic each other. Intravascular imaging (IVI) and cardiac computed tomography angiography (CCTA) aid in diagnosing SCAD and managing patients with acute chest pain.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS).
- Coronary artery spasm (CAS) is a primary cause of ischemic heart disease presenting with non-obstructive coronary lesions.
- Both SCAD and CAS can manifest with symptoms ranging from stable angina to ACS and may be underdiagnosed by coronary angiography.
Purpose of the Study:
- To present a case of a young woman with acute chest pain, highlighting the diagnostic challenges of SCAD and CAS.
- To illustrate the utility of advanced imaging techniques in differentiating and managing these conditions.
Main Methods:
- A case report of a young woman with acute chest pain and no traditional risk factors.
- Coronary angiography revealed stenosis, which progressed to spasm after wiring.
- Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) were used for detailed coronary assessment.
- Cardiac computed tomography angiography (CCTA) was employed for follow-up imaging.
Main Results:
- Initial angiography showed stenosis, but coronary wiring induced significant spasm.
- Intravascular imaging (OCT and IVUS) confirmed extensive SCAD, not obstructive disease.
- The patient was managed conservatively with medical therapy.
- CCTA at day four ruled out disease progression, allowing for discharge.
Conclusions:
- Combined intravascular imaging (IVI) is crucial for accurate diagnosis, risk stratification, and treatment planning in complex coronary artery disease.
- Cardiac computed tomography angiography (CCTA) serves as a valuable noninvasive tool for monitoring SCAD progression.
Background:
Over recent years, spontaneous coronary artery dissection (SCAD) has emerged as a no longer rare cause of acute coronary syndrome (ACS). On the other hand, coronary artery spasm (CAS) is the main cause of ischemic heart disease with non-obstructive coronary lesions. Clinical manifestations of both vary from stable angina to ACS or, rarely, sudden cardiac death. These entities may be underdiagnosed on a coronary angiography.
Case Presentation:
We report the case of a young woman presenting with acute chest pain and no coronary risk factors. Angiography revealed a focal subcritical stenosis of the right coronary artery. Coronary wiring resulted in diffuse and critical spasm. However, optical coherence tomography (OCT) and intravascular ultrasound (IVUS) showed extensive SCAD. She was therefore treated conservatively. On the fourth day, cardiac computed tomography angiography (CCTA) excluded disease progression, and then she was discharged on medical therapy.
Conclusions:
Combined IVI plays a vital role in providing accurate and detailed visualization of the coronary anatomy and thus allowing for more precise diagnosis, risk stratification, and treatment planning. CCTA can be considered a valuable tool in the noninvasive follow-up of SCAD.
