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Spontaneous coronary artery dissection causing acute myocardial infarction in a 62-year-old postmenopausal woman without co-morbidities: a case report.

Mujtaba S, Srinivas VS, Taub CC - J Med Case Rep (2012)

Bottom Line: A 62-year-old previously healthy postmenopausal Hispanic woman presented with chest pain and was found to have an ST elevation myocardial infarction.A full panel of tests was done to exclude underlying connective tissue disorders and vasculitis.On subsequent follow-up, our patient continued to do well and all work-up was reported as negative.

View Article: PubMed Central - HTML - PubMed

Affiliation: Jack D Weiler Hospital of the Albert Einstein College of Medicine, 1825 Eastchester Road, Bronx, NY, 10461-2372, USA. ctaub@montefiore.org.

ABSTRACT

Introduction: Spontaneous coronary artery dissection is an important yet rare cause of acute coronary syndrome. The available literature shows a higher risk factor for women, notably during pregnancy and puerperium. The incidence in postmenopausal women is exceedingly rare, and is more commonly seen in association with concurrent predisposing factors.We illustrate an extremely rare case of a 62-year-old post-menopausal woman presenting with an acute myocardial infarction secondary to spontaneous dissection of the left anterior descending artery. Subsequent investigations did not reveal the presence of any co-morbidities.To the best of our knowledge, our patient is one of the oldest documented cases of spontaneous coronary artery dissection on record, and is notable for having no known underlying risk factors for development of spontaneous coronary artery dissection.Given the paucity of literature on spontaneous coronary artery dissection, particularly in postmenopausal women, we believe this case will provide further insight into the clinical presentation and management of this rare entity.

Case presentation: A 62-year-old previously healthy postmenopausal Hispanic woman presented with chest pain and was found to have an ST elevation myocardial infarction. Cardiac catheterization revealed a dissection in her left anterior descending artery. Revascularization was deferred; our patient received appropriate medical management and remained asymptomatic. A full panel of tests was done to exclude underlying connective tissue disorders and vasculitis. On subsequent follow-up, our patient continued to do well and all work-up was reported as negative.

Conclusion: We describe the varied presentation and subsequent management of a case of spontaneous coronary artery dissection and highlight the importance of considering spontaneous coronary artery dissection as a differential diagnosis even in older, postmenopausal women.The consequences of a delay in diagnosis and appropriate management are associated with a high mortality and morbidity; hence we believe that reporting all cases of spontaneous coronary artery dissection, particularly in postmenopausal women, will add invaluable information to the limited literature on this rare condition.

No MeSH data available.


Related in: MedlinePlus

12-lead electrocardiogram showing ST elevations in the antero-lateral leads V2 to V5.
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Figure 1: 12-lead electrocardiogram showing ST elevations in the antero-lateral leads V2 to V5.

Mentions: An initial electrocardiogram was remarkable for ST elevations in the precordial leads (Figure 1), with a troponin I level of 0.02ng/ml. Her symptoms improved after receiving aspirin, clopidogrel, nitroglycerine, heparin, beta blockade and a statin. Repeat electrocardiograms after admission were remarkable for complete resolution of the ST segment elevation and our patient reported no further episodes of chest pain. Cardiac catheterization was performed which showed non-obstructive single vessel coronary artery disease with dissection in the mid portion of her left anterior descending artery, with significant luminal compromise (Figure 2). Intracoronary nitroglycerine was not given and no other tests were done to induce vasospasm. Because our patient was symptom free and demonstrated complete resolution of ST segment elevation, and there was no evidence of compromise in coronary flow, a decision was made to defer any revascularization and continue with medical management, including the addition of nifedipine. A full panel of tests, including erythrocyte sedimentation rate, C- reactive protein level, complement level, anti-nuclear antibody test, rheumatoid factor level, perinuclear anti-neutrophil cytoplasmic antibody and centrally accentuated anti-neutrophil cytoplasmic antibody tests, were found to be normal. Our patient continued to remain asymptomatic at two- and six-week follow-ups.


Spontaneous coronary artery dissection causing acute myocardial infarction in a 62-year-old postmenopausal woman without co-morbidities: a case report.

Mujtaba S, Srinivas VS, Taub CC - J Med Case Rep (2012)

12-lead electrocardiogram showing ST elevations in the antero-lateral leads V2 to V5.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539931&req=5

Figure 1: 12-lead electrocardiogram showing ST elevations in the antero-lateral leads V2 to V5.
Mentions: An initial electrocardiogram was remarkable for ST elevations in the precordial leads (Figure 1), with a troponin I level of 0.02ng/ml. Her symptoms improved after receiving aspirin, clopidogrel, nitroglycerine, heparin, beta blockade and a statin. Repeat electrocardiograms after admission were remarkable for complete resolution of the ST segment elevation and our patient reported no further episodes of chest pain. Cardiac catheterization was performed which showed non-obstructive single vessel coronary artery disease with dissection in the mid portion of her left anterior descending artery, with significant luminal compromise (Figure 2). Intracoronary nitroglycerine was not given and no other tests were done to induce vasospasm. Because our patient was symptom free and demonstrated complete resolution of ST segment elevation, and there was no evidence of compromise in coronary flow, a decision was made to defer any revascularization and continue with medical management, including the addition of nifedipine. A full panel of tests, including erythrocyte sedimentation rate, C- reactive protein level, complement level, anti-nuclear antibody test, rheumatoid factor level, perinuclear anti-neutrophil cytoplasmic antibody and centrally accentuated anti-neutrophil cytoplasmic antibody tests, were found to be normal. Our patient continued to remain asymptomatic at two- and six-week follow-ups.

Bottom Line: A 62-year-old previously healthy postmenopausal Hispanic woman presented with chest pain and was found to have an ST elevation myocardial infarction.A full panel of tests was done to exclude underlying connective tissue disorders and vasculitis.On subsequent follow-up, our patient continued to do well and all work-up was reported as negative.

View Article: PubMed Central - HTML - PubMed

Affiliation: Jack D Weiler Hospital of the Albert Einstein College of Medicine, 1825 Eastchester Road, Bronx, NY, 10461-2372, USA. ctaub@montefiore.org.

ABSTRACT

Introduction: Spontaneous coronary artery dissection is an important yet rare cause of acute coronary syndrome. The available literature shows a higher risk factor for women, notably during pregnancy and puerperium. The incidence in postmenopausal women is exceedingly rare, and is more commonly seen in association with concurrent predisposing factors.We illustrate an extremely rare case of a 62-year-old post-menopausal woman presenting with an acute myocardial infarction secondary to spontaneous dissection of the left anterior descending artery. Subsequent investigations did not reveal the presence of any co-morbidities.To the best of our knowledge, our patient is one of the oldest documented cases of spontaneous coronary artery dissection on record, and is notable for having no known underlying risk factors for development of spontaneous coronary artery dissection.Given the paucity of literature on spontaneous coronary artery dissection, particularly in postmenopausal women, we believe this case will provide further insight into the clinical presentation and management of this rare entity.

Case presentation: A 62-year-old previously healthy postmenopausal Hispanic woman presented with chest pain and was found to have an ST elevation myocardial infarction. Cardiac catheterization revealed a dissection in her left anterior descending artery. Revascularization was deferred; our patient received appropriate medical management and remained asymptomatic. A full panel of tests was done to exclude underlying connective tissue disorders and vasculitis. On subsequent follow-up, our patient continued to do well and all work-up was reported as negative.

Conclusion: We describe the varied presentation and subsequent management of a case of spontaneous coronary artery dissection and highlight the importance of considering spontaneous coronary artery dissection as a differential diagnosis even in older, postmenopausal women.The consequences of a delay in diagnosis and appropriate management are associated with a high mortality and morbidity; hence we believe that reporting all cases of spontaneous coronary artery dissection, particularly in postmenopausal women, will add invaluable information to the limited literature on this rare condition.

No MeSH data available.


Related in: MedlinePlus