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06 February 2019 : Case report  USA

Spontaneous Coronary Artery Dissection Masquerading as Coronary Artery Stenosis in a Young Patient

Challenging differential diagnosis, Rare disease

Muhammad Shabbir Rawala1ABCDEF*, S. Tahira Shah Naqvi2AEF, Muhammad Yasin1EF, Syed Bilal Rizvi3ABDEF

DOI: 10.12659/AJCR.913522

Am J Case Rep 2019; 20:159-162

Abstract

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is primarily found in females. SCAD can have many precipitating factors such as exercise, trauma, pregnancy, drugs, and connective tissue disease. Prognosis is poor for left main stem, left anterior descending (LAD) artery, and multivessel involvement, especially for females.

CASE REPORT: We present a case of young African American male with sickle cell disease who presented with chest pain associated with shortness of breath. He was found to have non-ST elevation myocardial infarction (NSTEMI). He was diagnosed with SCAD during catheterization with the help of intravascular ultrasound imaging. Three drug-eluting stents were placed to cover the proximal LAD vessel along its whole length until resolution of the lesion. The patients’ hospital course was complicated by an additional finding of left ventricular thrombus, possibly a complication of NSTEMI, which was treated with anticoagulation to complete resolution.

CONCLUSIONS: SCAD is fatal, it can proceed to cause myocardial infarction as in this particular patient’s case, and sudden death if not recognized early. It can be missed on angiography alone; further intracoronary imaging such as intravascular ultrasound and optical computed tomography should be used to confirm the diagnosis of SCAD so that early and appropriate treatment can ensue.

Keywords: Coronary Artery Disease, Dissection, Anemia, Sickle Cell, cardiac catheterization, Chest Pain, Coronary Angiography, Coronary Stenosis, Coronary Vessel Anomalies, Diagnosis, Differential, Dyspnea, Non-ST Elevated Myocardial Infarction, Vascular Diseases

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923