Recurrent Spontaneous Coronary Artery Dissection as the Cause of Repeated Myocardial Infarctions
Arnon Møldrup Knudsen1, Nicolaj Brejnholt Støttrup2, Henrik Hager1
1Department of Pathology Aarhus University Hospital Aarhus Denmark.
Insights
Spontaneous coronary artery dissection (SCAD) is a serious condition causing heart attacks. This case details a fatal outcome from recurrent SCAD, emphasizing its diagnostic importance in women.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) involves intramural hematoma leading to coronary artery obstruction.
- SCAD is an important cause of myocardial infarction, particularly in younger women.
Purpose of the Study:
- To present a case of recurrent SCAD with a fatal outcome.
- To highlight the diagnostic considerations for SCAD in patients presenting with myocardial infarction.
Main Methods:
- Case report of a 51-year-old female with acute myocardial infarction and cardiogenic shock.
- Diagnosis of severe SCAD affecting the proximal left coronary artery.
- Management involved complex percutaneous coronary intervention with stent insertion and revascularization.
Main Results:
- The patient experienced cardiac arrest during intervention, requiring cardiopulmonary support.
- Post-intervention, severe heart failure and multiple organ failure developed.
- The patient ultimately died due to complications of recurrent SCAD.
Conclusions:
- Recurrent SCAD can lead to severe complications and mortality.
- SCAD should be considered in the differential diagnosis of myocardial infarction in female patients.
- This case underscores the critical need for timely SCAD diagnosis and management.
Abstract:
Spontaneous coronary artery dissection (SCAD) is characterized by intramural hematoma in a coronary artery leading to partial or complete vessel obstruction. A 51-year-old female was hospitalized with acute myocardial infarction and cardiogenic shock. She was diagnosed with severe SCAD, affecting the proximal left coronary artery. A complex percutaneous coronary intervention, complicated by cardiac arrest and need for cardio pulmonary support, succeeded with stent insertion and revascularization. In the following days, the patient developed severe heart failure due to extensive cardiac reperfusion injury and subsequently experienced multiple organ failure, ultimately resulting in death. The patient had previously been acutely hospitalized twice with myocardial infarctions and both the times was also diagnosed with SCAD affecting the left coronary artery. This case highlights an unfortunate patient outcome due to recurrent SCAD and serves as an important reminder to consider SCAD differential diagnostically in younger female patients with myocardial infarction.
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