Spontaneous Coronary Artery Dissection: A Rare Cause of an Acute Myocardial Infarction
Presenter
Giorgi Kochiashvili, MD, Mary Washington Hospital, Fredericksburg, VA
Giorgi Kochiashvili, MD, Mary Washington Hospital, Fredericksburg, VA and Micaela Iantorno, M.D., Mary Washington Hospital, FAIRFAX station , VA
Keywords: Acute Coronary Syndromes (ACS), Coronary, Hemodynamic Support and Women's Health
Background
A 29-year-old female with no significant PMH presented to the ED with a chief complaint of chest pain, loss of consciousness, and altered mental state, patient had elevated troponin and an EKG showed diffuse ST elevations
Methods
We hope our presentation of a rare case of SCAD will be interesting for the audience
Results
The patient was taken to the cath lab, where coronary angiography showed focal 95% stenosis of the proximal LAD artery with TIMI 1 flow concerning spontaneous coronary artery dissection(SCAD). A decision was made to proceed with PCI to LAD. The procedure was complicated by retrograde advancement of dissection/hematoma to the left main coronary artery requiring further stenting with overlapping stents from ostial left main to proximal LAD. During the procedure patient developed multiple cardiac arrests with PEA requiring ACLS, later followed by initiation of vasopressors due to hemodynamical instability and emergent intubation. Additionally, an Impella device was placed for left ventricular support and cardiogenic shock, later followed by transfer to the ICU.
Conclusions
SCAD was previously perceived as a rare cause of non-atherosclerotic coronary artery disease. However, currently, it is exhibiting a rising incidence rate in young and middle-aged females without conventional cardiac risk factors compared to males with a ratio of 9:1. It is observed that SCAD accounts for nearly 35% of acute coronary syndrome cases in females less than 60 years of age with the high frequency seen during pregnancy, peripartum period, and with the use of exogenous hormones although the exact etiology remains unclear[1]. Impella is a short-term mechanical circulatory support device designed to provide hemodynamic support for a wide range of clinical conditions ranging from prophylactic insertion for high-risk invasive coronary artery[2] procedures to the management of cardiogenic shock[3], it was crucial in our case to use Impella device for the needs of hemodynamic support with favorable outcomes.