Spontaneous coronary artery dissection: Rare but challenging
Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical)...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2014-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501300055P.pdf |
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| author | Putniković Biljana Ilić Ivan Panić Miloš Aleksić Aleksandar Vidaković Radosav Nešković Aleksandar N. |
| author_facet | Putniković Biljana Ilić Ivan Panić Miloš Aleksić Aleksandar Vidaković Radosav Nešković Aleksandar N. |
| author_sort | Putniković Biljana |
| collection | DOAJ |
| description | Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause
of the acute coronary syndrome. It occurs mostly in patients without
atherosclerotic coronary artery disease, carrying fairly high early mortality
rate. The treatment of choice (interventional, surgical, or medical) for this
serious condition is not well-defined. Case report. A 41-year old woman was
admitted to our hospital after the initial, unsuccessful thrombolytic
treatment for anterior myocardial infarction administered in a local hospital
without cardiac catheterization laboratory. Immediate coronary angiography
showed spontaneous coronary dissection of the left main and left anterior
descending coronary artery. Follow-up coronary angiography performed 5 days
after, showed extension of the dissection into the circumflex artery. Because
of preserved coronary blood flow (thrombolysis in myocardial infarction -
TIMI II-III), and the absence of angina and heart failure symptoms, the
patient was treated medicaly with dual antiplatelet therapy, a low molecular
weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE)
inhibitor and a statin. The patient was discharged after 12 days. On
follow-up visits after 6 months and 2 years, the patient was asymptomatic,
and coronary angiography showed the persistence of dissection with preserved
coronary blood flow. Conclusion. Immediate coronary angiography is necessary
to assess the coronary anatomy and extent of SCAD. In patients free of angina
or heart failure symptoms, with preserved coronary artery blood flow, medical
therapy is a viable option. Further evidence is needed to clarify optimal
treatment strategy for this rare cause of acute coronary syndrome. |
| format | Article |
| id | doaj-art-dcbbf49a998944a99ad8f05faf76edec |
| institution | Kabale University |
| issn | 0042-8450 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-dcbbf49a998944a99ad8f05faf76edec2025-08-20T03:25:12ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502014-01-0171331131610.2298/VSP120819055P0042-84501300055PSpontaneous coronary artery dissection: Rare but challengingPutniković Biljana0Ilić Ivan1Panić Miloš2Aleksić Aleksandar3Vidaković Radosav4Nešković Aleksandar N.5Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, BelgradeDepartment of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, BelgradeDepartment of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, BelgradeDepartment of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, BelgradeDepartment of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, BelgradeDepartment of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, BelgradeIntroduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical) for this serious condition is not well-defined. Case report. A 41-year old woman was admitted to our hospital after the initial, unsuccessful thrombolytic treatment for anterior myocardial infarction administered in a local hospital without cardiac catheterization laboratory. Immediate coronary angiography showed spontaneous coronary dissection of the left main and left anterior descending coronary artery. Follow-up coronary angiography performed 5 days after, showed extension of the dissection into the circumflex artery. Because of preserved coronary blood flow (thrombolysis in myocardial infarction - TIMI II-III), and the absence of angina and heart failure symptoms, the patient was treated medicaly with dual antiplatelet therapy, a low molecular weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE) inhibitor and a statin. The patient was discharged after 12 days. On follow-up visits after 6 months and 2 years, the patient was asymptomatic, and coronary angiography showed the persistence of dissection with preserved coronary blood flow. Conclusion. Immediate coronary angiography is necessary to assess the coronary anatomy and extent of SCAD. In patients free of angina or heart failure symptoms, with preserved coronary artery blood flow, medical therapy is a viable option. Further evidence is needed to clarify optimal treatment strategy for this rare cause of acute coronary syndrome.http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501300055P.pdfacute coronary syndromedissectioncoronary angiographydiagnosistreatment outcome |
| spellingShingle | Putniković Biljana Ilić Ivan Panić Miloš Aleksić Aleksandar Vidaković Radosav Nešković Aleksandar N. Spontaneous coronary artery dissection: Rare but challenging Vojnosanitetski Pregled acute coronary syndrome dissection coronary angiography diagnosis treatment outcome |
| title | Spontaneous coronary artery dissection: Rare but challenging |
| title_full | Spontaneous coronary artery dissection: Rare but challenging |
| title_fullStr | Spontaneous coronary artery dissection: Rare but challenging |
| title_full_unstemmed | Spontaneous coronary artery dissection: Rare but challenging |
| title_short | Spontaneous coronary artery dissection: Rare but challenging |
| title_sort | spontaneous coronary artery dissection rare but challenging |
| topic | acute coronary syndrome dissection coronary angiography diagnosis treatment outcome |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2014/0042-84501300055P.pdf |
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