Coronary artery dissection--a case report

Coronary artery dissection, both spontaneous and catheter-induced, is associated with a significant morbidity and mortality. The authors present a case of a middle-aged woman with spontaneous right coronary artery dissection causing inferior wall myocardial infarction and left coronary artery dissection at the time of coronary arteriography. It is suggested that emergency aortocoronary bypass surgery be performed preceded by insertion of an intra-aortic balloon in acute evolving cases where coronary anatomy is favorable to limit infarction and avert loss of life.     

Spontaneous dissection of the left main coronary artery: case report and review of the literature

Abstract Primary coronary artery dissection is a rare cause of myocardial infarction. It should be suspected in young, healthy females. It is a condition which is treated by myocardial revascularisation. (Aust NZ J Med 1991; 21: 891–892.)     

Spontaneous rupture of a coronary artery aneurysm: a case report and review of the literature

Coronary artery aneurysm (CAA) is a rare disorder, characterized by abnormal dilatation of a localized portion or diffuse segments of the coronary artery. CAA may cause angina, myocardial infarction, sudden death due to thrombosis, embolisation, or rupture. In this report, a 63 year old Turkish male patient is presented who had an acute non-Q wave myocardial infarction due to spontaneous rupture of the left circumflex artery aneurysm. An extremely rare clinical presentation of rupture of a left circumflex CAA is discussed.     

Spontaneous coronary artery dissection: A single-center case series and literature review

Background

Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS). Better recognition and diagnosis has raised awareness of this condition. However, the pathophysiology of SCAD and its prognosis are still little understood. We aimed to investigate the characteristics and prognosis of patients with SCAD, and subsequently performed a review of literature.

Spontaneous coronary artery dissection associated with oral contraceptive use: a case report and review of the literature

Spontaneous coronary artery dissection (SCAD) represents a rare cause of acute coronary syndromes with complex pathohysiology. We briefly describe a 50-year-old woman, without traditional cardiovascular risk factors, hospitalized for an acute ST-elevation myocardial infarction and treated with thrombolytic therapy. Notably, the patient was on oral contraceptives for the past 10 years. Coronary angiography showed a dissection of the distal left anterior descending artery. She was treated conservatively and her clinical status improved without evidence of continuing ischemia, while a repeated catheterization 6 months later showed a complete resolution of the dissection. It has been speculated that the female hormones may be responsible for the increased incidence of SCAD among women particularly during the peripartum period or during the exogenous administration of such agents. A systematic review of the literature revealed 4 further cases reporting an association of SCAD with oral contraceptive use.     

Woven coronary artery: a case report and review of literature

Woven coronary artery is an extremely rare and clearly undefined coronary malformation. Up to now, very few cases have been reported. In this anomaly, epicardial coronary artery are branched into thin channels at any segment of the coronary artery and then these longitudinal twisted thin channels merge again as the main coronary lumen. This anomaly is regarded as a benign condition since there is completely normal blood flow after the distal segment of the abnormal coronary artery. In this case report, we present a 48-year-old male patient with a woven coronary artery anomaly in the circumflex artery and who had been followed up for 5 years.     

Acute left main coronary artery occlusion--a case report and review of the literature

Acute left main coronary artery (LMCA) occlusion is rare and typically fatal. According to the recent literature, only three cases have been reported surviving emergent coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) caused by total LMCA occlusion. We report the case of a 52-year-old man presenting with total occlusion of the LMCA associated with acute anterolateral myocardial infarction and cardiogenic shock. The patient's dominant right coronary artery did not supply the collaterals to the left coronary system. After ineffective thrombolysis the patient underwent successful emergent CABG for the management of uncontrollable cardiogenic shock. Emergent CABG, though controversial, appears to be a feasible approach for patients with AMI in life-threatening situations, when other attempts at reperfusion have been unsuccessful.     

Anomalous left coronary artery from the pulmonary artery: case report and review of the literature

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an uncommon occurrence, usually diagnosed at a young age. We report a 71-year-old patient who died suddenly of acute bilateral bronchopneumonia, and was found to have ALCAPA at autopsy. The patient had reported no cardiac symptoms during his lifetime. Autopsy revealed collateral connections between the left coronary artery (LCA) and right coronary artery (RCA), which were diffusely dilated, calcified and atherosclerotic.     

Spontaneous pneumopericardium: case report and review of the literature

An 84-year-old man presented with acute dyspnea and chest pain attributed to his long medical history of cardiorespiratory problems. Admission chest roentgenogram revealed a moderate pneumopericardium and a cavitary lesion in the base of the right lung. The lesion was found to be a bronchogenic carcinoma perforating through the upper pericardium to form a bronchopericardial fistula, confirmed by autopsy. A review of the literature concerning the various causes of pneumopericardium, the clinical features and the principles of treatment is included.     

Recurrent spontaneous coronary artery dissection: A case report and review of the literature

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Recurrent spontaneous dissection is even more rare. A case of recurrent coronary artery dissection is reported and the literature is reviewed.     

Spontaneous coronary artery dissection and associated CT coronary angiographic findings: a case report and review

We report a case of an acute coronary syndrome in a 21-year-old male with invasive coronary angiography and computed tomography (CT) coronary angiography showing a spontaneous dissection of the left anterior descending artery. To our knowledge the CT coronary angiographic appearance of spontaneous coronary artery dissection has been reported only once before. We describe the role CT coronary angiography may have in the evaluation of coronary dissection as well as potential treatment options.     

Spontaneous coronary artery dissection: case series and review

Spontaneous coronary artery dissection (SCAD) is a rare but important cause of acute coronary syndromes. SCAD can cause unstable angina, acute myocardial infarction, and sudden death. Predisposing factors include atherosclerosis, the peripartum period, and structural and inflammatory conditions affecting the arterial wall. The diagnosis of coronary dissection is usually made by coronary angiography. Prompt diagnosis and treatment of patients with dissection improves survival. Therapeutic options include medical therapy, percutaneous coronary intervention, and surgery. We present a series of patients with spontaneous coronary artery dissection at our institution. The etiology, pathogenesis, diagnosis, treatment, and prognosis of patients with coronary dissection are reviewed.     

Spontaneous coronary artery dissection: report of two cases and a 50-year review of the literature

Spontaneous coronary artery dissection (SCAD) is a rare condition that can cause acute myocardial infarction and sudden death. This entity occurs predominantly in women. Although several mechanisms have been postulated, no single etiology completely explains the pathogenesis of SCAD. Patients who survive SCAD have been treated with various modalities. Prompt diagnosis and early institution of appropriate treatment are usually associated with successful outcome. We report two cases of SCAD successfully identified and treated with coronary stenting as well as a comprehensive review of cases of SCAD published since 1952.     

Spontaneous coronary artery dissection: Case series and review of literature

AimSpontaneous coronary artery dissection (SCAD) is a less recognized cause of ST elevation myocardial infarction (STEMI) in clinical practice. The aim of this communication is to describe a case series in South Asian population and highlight on the long-term clinical outcomes on conservative management.MethodsA retrospective analysis of data of five patients (6 instances) of SCAD managed in a tertiary care center during January 1994 to June 2015 was done. Clinical, angiographic, therapeutic, and follow-up data till end of June 2015 are analyzed.ResultsAll patients were young (mean – 33 years) and predominantly male. Etiology of SCAD was diverse and included peripartum state, vigorous activity and atherosclerosis. Left anterior descending (LAD) coronary artery was predominantly involved and the majority had angiographic type 1 SCAD. Medical treatment provides excellent long-term benefits. Coronary stenting provided symptomatic benefit in a patient with favorable anatomy.ConclusionsClinical recognition of SCAD is difficult. It should be suspected in peripartum state, young females and in presence of other precipitating factors. Coronary angiography is essential for establishing the diagnosis. Medical treatment provides favorable long-term survival.Implications and practiceThe awareness of SCAD is important for all clinicians involved in STEMI care. A prompt suspicion can avoid administration of thrombolytic therapy. Early coronary angiography will provide an accurate diagnosis and help in deciding appropriate therapy. Percutaneous intervention can be challenging.     

Coronary artery stenting for spontaneous coronary artery dissection: A case report and review of the literature

Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndromes. It occurs in three major groups: in young women in the peripartum period, in patients with atherosclerotic disease, and in an idiopathic group. There are a number of associated conditions, but the pathogenesis remains unclear. Diagnosis can only be made at angiography. Treatments include medical therapy, coronary artery bypass grafts, and newer interventional procedures. We report on a case of spontaneous coronary artery dissection involving the left circumflex artery in a young adult male presenting with a myocardial infarction after exercise. There were no risk factors for coronary artery disease and no evidence of atherosclerosis on angiography. The dissection was treated with primary coronary artery stenting without predilation, achieving an excellent result. To our knowledge, this is the third known case of successful coronary artery stenting for this condition and the first case of primary stenting without prior angioplasty. Cathet. Cardiovasc. Diagn. 45:280–286, 1998. © 1998 Wiley-Liss, Inc.     

Anomalous origin of the right coronary artery from the left coronary sinus: case report and literature review

A 41-year-old man with no relevant cardiac history presented for evaluation of episodic syncope. Electrocardiography showed sinus rhythm with right bundle-branch block and Q waves in leads II, III, and aVF. Subsequent exercise treadmill testing and technetium 99m sestamibi study revealed a reversible posterior defect. Coronary angiography later showed a right coronary artery that arose from the left coronary sinus--an anomaly that has been associated with angina, myocardial infarction, and sudden cardiac death. After being informed of the potential risks and options associated with this anomaly, the patient chose long-term beta-blocker medical therapy. At follow-up, this treatment appeared to have resolved his episodic syncope.     

Spontaneous coronary artery dissection of the left circumflex artery causing cardiac tamponade and presenting with atrial fibrillation: a case report and review of the literature

Spontaneous coronary artery dissection is rare. When it does occur, it can present in a myriad of ways and can mimic more common clinical scenarios. Undiagnosed it can be fatal. In this article, the authors present a case of coronary artery dissection in a middle aged man presenting as fast atrial fibrillation with hemodynamic compromise. He was unsuccessfully cardioverted and later arrested and died. Postmortem showed a ruptured dissection of the left circumflex artery causing cardiac tamponade and death. Incidence, associations, pathophysiology, investigations, and treatment options are reviewed.     

Pregnancy associated spontaneous coronary artery dissection: A case report and review of literature

BACKGROUNDPregnancy-associated spontaneous coronary artery dissection (PSCAD) is an important cause of chest pain and acute myocardial infarction in pregnant and postpartum women. Pregnancy is considered an isolated risk factor for spontaneous coronary artery dissection. The etiology, pathogenesis, and incidence of PSCAD are not known.CASE SUMMARYWe present a case of a 33-year-old postpartum female who presented with sudden onset chest pain and was diagnosed with spontaneous coronary artery dissection and needed urgent catheterization revealing left anterior descending coronary artery dissection. She underwent emergent coronary artery bypass graft surgery with good post-operative recovery.CONCLUSIONMost patients with PSCAD can be managed conservatively with medical management and have good outcomes. Patients with high-risk presentations benefit from the invasive approach. Coronary artery bypass graft may be required in select few patients based on angiography findings. Due to the risk of recurrent spontaneous coronary artery dissection, subsequent pregnancies are discouraged.