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Case Report: Spontaneous coronary artery dissection presenting as MINOCA in uncontrolled Graves' disease
Yunfeng Pan1, Hao Han1, Jijie Chen2
1Department of Cardiovascular Medicine, Yiwu Hospital of Traditional Chinese Medicine, Yiwu, China.
Background:
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction with non-obstructive coronary arteries (MINOCA). Although Graves' disease is a well-established cause of coronary vasospasm, its potential association with structural coronary arterial injury remains incompletely understood. We report a case of hyperthyroidism-associated SCAD that provides clinical insight into a possible link between severe thyrotoxicosis and coronary arterial vulnerability.
Case Presentation:
We report a 56-year-old female with uncontrolled Graves' disease presenting with an acute ST-segment elevation myocardial infarction (STEMI). Despite prominent inferior ST-segment elevations, emergent coronary angiography revealed a long narrowing extending from the mid to the distal tip of the left anterior descending (LAD) artery with preserved TIMI 3 flow. The lesion's lack of response to intracoronary nitroglycerin supported a working diagnosis of MINOCA. Given the concurrent severe thyrotoxicosis and the substantial risk of precipitating thyroid storm during invasive evaluation, a staged diagnostic approach was adopted: acute-phase management prioritized conservative cardiovascular and antithyroid therapy, while definitive intravascular imaging was deferred. Follow-up intravascular ultrasound (IVUS) at three months demonstrated a persistent intramural hematoma, confirming the diagnosis of SCAD. The patient remained asymptomatic at the one-year follow-up.
Conclusions:
This case suggests that severe thyrotoxicosis may contribute to coronary arterial vulnerability and the development of SCAD. It also highlights the diagnostic challenges of complex MINOCA presentations in patients with uncontrolled hyperthyroidism. In selected cases, a staged diagnostic strategy with deferred intracoronary imaging after endocrinological stabilization may provide a safe and effective approach to diagnostic confirmation while minimizing procedural risk.
