Spontaneous coronary artery dissection: a rare cause of acute coronary syndrome
Location
Auditorium Pond Side
Start Date
26-2-2014 10:30 AM
Abstract
Spontaneous coronary artery dissection (SCAD) is an uncommon and rare cause of acute coronary syndrome (ACS) and sudden cardiac death. A number of conditions and diseases are associated with SCAD. Various risk factors for SCAD include pregnancy, intensive exercise, cocaine abuse and connective tissue disorders like Ehlers-Danlos disease, and Marfan's Syndrome. We present here a case of SCAD which presented with atrial fibrillation and acute coronary syndrome in an unusual presentation. A 71 year man, who was a known case of hypertension and dyslipidemia, presented to the emergency department with typical cardiac chest pain and palpitations of 2 hours duration. The examination revealed a pulse of 138 bpm irregularly irregular, BP 115/75 mmHg, variable first and normal second heart sounds. The lungs were clear on auscultation. The electrocardiogram revealed atrial fibrillation with rapid ventricular rate. His heart rate was controlled with beta blockers and treatment commenced for acute coronary syndrome including anticoagulation. His base line blood reports were within normal limits and two serial Troponin I tests were negative. Coronary angiogram was done which showed dissection of the left coronary system including the left anterior descending artery from ostium to mid portion and extending to the diagonal branch. The left circumflex artery also showed dissection going into the obtuse marginal branch. The right coronary artery showed plaque formation with 30 to 40% stenosis without any dissection. The patient underwent CABG on the same day on an emergent basis. Post procedure he suffered a limited stroke from which he recovered uneventfully. He was discharged home after recovery and is being followed in the clinic where he is doing well.
Keywords: spontaneous, dissection, CAD, atrial fibrillation, myocardial infarction
Spontaneous coronary artery dissection: a rare cause of acute coronary syndrome
Auditorium Pond Side
Spontaneous coronary artery dissection (SCAD) is an uncommon and rare cause of acute coronary syndrome (ACS) and sudden cardiac death. A number of conditions and diseases are associated with SCAD. Various risk factors for SCAD include pregnancy, intensive exercise, cocaine abuse and connective tissue disorders like Ehlers-Danlos disease, and Marfan's Syndrome. We present here a case of SCAD which presented with atrial fibrillation and acute coronary syndrome in an unusual presentation. A 71 year man, who was a known case of hypertension and dyslipidemia, presented to the emergency department with typical cardiac chest pain and palpitations of 2 hours duration. The examination revealed a pulse of 138 bpm irregularly irregular, BP 115/75 mmHg, variable first and normal second heart sounds. The lungs were clear on auscultation. The electrocardiogram revealed atrial fibrillation with rapid ventricular rate. His heart rate was controlled with beta blockers and treatment commenced for acute coronary syndrome including anticoagulation. His base line blood reports were within normal limits and two serial Troponin I tests were negative. Coronary angiogram was done which showed dissection of the left coronary system including the left anterior descending artery from ostium to mid portion and extending to the diagonal branch. The left circumflex artery also showed dissection going into the obtuse marginal branch. The right coronary artery showed plaque formation with 30 to 40% stenosis without any dissection. The patient underwent CABG on the same day on an emergent basis. Post procedure he suffered a limited stroke from which he recovered uneventfully. He was discharged home after recovery and is being followed in the clinic where he is doing well.
Keywords: spontaneous, dissection, CAD, atrial fibrillation, myocardial infarction