A Case Report of a 36-year-old Male Diagnosed with a Spontaneous Coronary Artery Dissection
Stephen DeWitt1, Jacob McClinton1, Daniel Jarrell1
1Memorial Health System, Marietta Memorial Hospital Department of Emergency Medicine, Marietta, OH.
Insights
A young man with atypical chest pain was diagnosed with spontaneous coronary artery dissection (SCAD) after initial ECGs were inconclusive. Prompt cardiac catheterization confirmed SCAD, leading to successful treatment and discharge.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Emergency Medicine
Background:
- Acute coronary syndrome (ACS) typically presents with classic symptoms, but atypical presentations can occur.
- Electrocardiogram (ECG) interpretation is crucial in diagnosing ACS, though initial findings can be non-diagnostic.
- Spontaneous coronary artery dissection (SCAD) is a rare but serious cause of myocardial infarction, often affecting younger individuals.
Purpose of the Study:
- To report a case of atypical acute coronary syndrome (ACS) ultimately diagnosed as spontaneous coronary artery dissection (SCAD).
- To highlight the importance of serial ECG review and troponin levels in diagnosing SCAD.
- To illustrate the diagnostic and management pathway for SCAD.
Main Methods:
- Case report of a 36-year-old male presenting with atypical symptoms suggestive of ACS.
- Serial electrocardiogram (ECG) interpretation, including high-sensitivity troponin levels.
- Left heart catheterization to diagnose coronary artery abnormalities.
- Echocardiogram to assess cardiac function and myocardial wall motion.
Main Results:
- Initial ECG was non-diagnostic; subsequent review revealed borderline ST elevation after elevated troponin.
- Left heart catheterization identified spontaneous coronary artery dissection (SCAD) of the distal left anterior descending (LAD) artery.
- Echocardiogram showed preserved ejection fraction (EF) with regional hypokinesis.
- Patient was treated with dual antiplatelet therapy and discharged within 48 hours.
Conclusions:
- Atypical presentations of ACS can mask serious underlying conditions like SCAD.
- Serial ECG monitoring and cardiac biomarkers are vital for diagnosing SCAD, even with initially non-diagnostic findings.
- SCAD can be successfully managed with timely diagnosis and appropriate medical therapy, even in the acute setting.
Abstract:
This case report discusses a 36-year-old male who presented to the emergency department with an atypical story for acute coronary syndrome (ACS). Initially, the patient was felt to have a non-diagnostic electrocardiogram (ECG). Once the laboratory test results were obtained and the initial high-sensitivity troponin was noted to be elevated, the initial ECG was again reviewed. The patient was felt this time to have an abnormal ECG, demonstrating borderline ST elevation in leads I, aVL, and V2-V5. The interventional cardiologist on call was contacted, and the cardiac catheterization lab was activated. Upon left heart catheterization, the patient was found to have a spontaneous coronary artery dissection (SCAD) of the distal left anterior descending (LAD) artery. Post-catheterization, the patient was observed on cardiac telemetry and started on dual antiplatelet therapy. Echocardiogram revealed a preserved ejection fraction (EF), but hypokinesis of the apical anterior, anterolateral, inferior, and apical myocardium. The patient was discharged within 48 hours without any complications.
Topics:
Electrocardiogram, ECG, cardiology, acute coronary syndrome, spontaneous coronary artery dissection, SCAD.
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