Document Type : Case Report
Resident Physician, Department of Cardiology, Hospital de Base, Faculty of Medicine of São José do Rio Preto (FAMERP), São Paulo, Brazil
Associate Professor, Department of Hemodynamics and Interventional Cardiology, Faculty of Medicine of São José do Rio Preto (FAMERP), São Paulo, Brazil
Adjunct Professor, Department of Cardiology and Cardiovascular Surgery, Faculty of Medicine of São José do Rio Preto (FAMERP), São Paulo, Brazil
BACKGROUND: The etiology of spontaneous dissection of coronary artery (SDCA) is not well understood yet. Different studies have linked this entity to pregnancy, physical stress, collagen diseases and vasculitis. In general, patients do not exhibit the classic risk factors for coronary artery disease, which mandates the suspicion of this condition, especially in young adults with acute coronary syndrome. CASE REPORT: In this article, we report the case of a 63-year old male patient, asymptomatic, who came for periodic evaluation and after evaluation by exercise and myocardial scintigraphy had high suspicion for severe coronary artery disease and underwent coronary angiography, which showed spontaneous dissection of the left and right branches of the coronary arteries. CONCLUSION: The choice of therapeutic strategies (clinics, percutaneous or surgical) remains uncertain and should be individualized by the features and form of presentation of the SDCA.
- Vrints CJ. Spontaneous coronary artery dissection. Heart 2010; 96(10): 801-8.
- Mortensen KH, Thuesen L, Kristensen IB, Christiansen EH. Spontaneous coronary artery dissection: A Western Denmark Heart Registry study. Catheter Cardiovasc Interv 2009; 74(5): 710-7.
- Leone F, Macchiusi A, Ricci R, Cerquetani E, Reynaud M. Acute myocardial infarction from spontaneous coronary artery dissection a case report and review of the literature. Cardiol Rev 2004; 12(1): 3-9.
- Khan NU, Miller MJ, Babb JD, Ahmed S, Saha PK, Shammas RL, et al. Spontaneous coronary artery dissection. Acute Card Care 2006; 8(3): 162-71.
- Saw J. Coronary angiogram classification of spontaneous coronary artery dissection. Catheter Cardiovasc Interv 2014; 84(7): 1115-22.
- Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, et al. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation 2012; 126(5): 579-88.
- Arnold JR, West NE, van Gaal WJ, Karamitsos TD, Banning AP. The role of intravascular ultrasound in the management of spontaneous coronary artery dissection. Cardiovasc Ultrasound 2008; 6: 24.
- Vijayaraghavan R, Verma S, Gupta N, Saw J. Pregnancy-related spontaneous coronary artery dissection. Circulation 2014; 130(21): 1915-20.
- Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D, et al. Spontaneous coronary artery dissection: Association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv 2014; 7(5): 645-55.
- Lie JT, Berg KK. Isolated fibromuscular dysplasia of the coronary Arteries with spontaneous dissection and myocardial infarction. Hum Pathol 1987; 18(6): 654-6.
- Brodsky SV, Ramaswamy G, Chander P, Braun A. Ruptured cerebral aneurysm and acute coronary artery dissection in the setting of multivascular fibromuscular dysplasia: A case report. Angiology 2007; 58(6): 764-7.
- Saw J, Poulter R, Fung A, Wood D, Hamburger J, Buller CE. Spontaneous coronary artery dissection in patients with fibromuscular dysplasia: A case series. Circ Cardiovasc Interv 2012; 5(1): 134-7.
- Tokura M, Taguchi I, Kageyama M, Nasuno T, Nishiyama Y, Koshiji N, et al. Clinical features of
- spontaneous coronary artery dissection. J Cardiol 2014; 63(2): 119-22.
- Hering D, Piper C, Hohmann C, Schultheiss HP, Horstkotte D. Prospective study of the incidence, pathogenesis and therapy of spontaneous, by coronary angiography diagnosed coronary artery dissection. Z Kardiol 1998; 87(12): 961-70.
- Russo V, Marrozzini C, Zompatori M. Spontaneous coronary artery dissection: Role of coronary CT angiography. Heart 2013; 99(9): 672-3.
- Nakashima T, Noguchi T, Morita Y, Sakamoto H, Goto Y, Ishihara M, et al. Detection of intramural hematoma and serial non-contrast T1-weighted magnetic resonance imaging findings in a female patient with spontaneous coronary artery dissection. Circ J 2013; 77(11): 2844-5.
- Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324(7329): 71-86.
- Choi JW, Davidson CJ. Spontaneous multivessel coronary artery dissection in a long-distance runner successfully treated with oral antiplatelet therapy. J Invasive Cardiol 2002; 14(11): 675-8.
- Shamloo BK, Chintala RS, Nasur A, Ghazvini M, Shariat P, Diggs JA, et al. Spontaneous coronary artery dissection: Aggressive vs. conservative therapy. J Invasive Cardiol 2010; 22(5): 222-8.
- Zupan I, Noc M, Trinkaus D, Popovic M. Double vessel extension of spontaneous left main coronary artery dissection in young women treated with thrombolytics. Catheter Cardiovasc Interv 2001; 52(2): 226-30.
- Nienaber CA, Powell JT. Management of acute aortic syndromes. Eur Heart J 2012; 33(1): 26-35b.
- Nogueira de Macedo R, de Paula Miranda S, Vieira da Costa RL. Spontaneous coronary artery dissection - a diagnosis to be considered in young patients presenting with acute myocardial infarction. J Invasive Cardiol 2009; 21(12): E245-E247.
- Yoshida K, Mori S, Tomari S, Murakami F, Matsuura A, Hibi M, et al. Coronary artery bypass grafting for spontaneous coronary artery dissection: A case report and a review of the literature. Ann Thorac Cardiovasc Surg 2000; 6(1): 57-60.