Am Heart Hosp J. 2011;9(2):125–7
Lozenge Reference
Case Report
Spontaneous Coronary Artery Dissection Presenting with Stroke
Saad Tariq, MD1 and Muhammad Usman Mustafa, MUA, MD, FACC2
Spontaneous coronary artery dissection is a rare and potentially life-threatening condition that can cause rapid deterioration and fatal myocardial infarction. A 60-year-old Caucasian male was admitted with a complaint of left-sided numbness followed by weakness in the left arm and leg. Magnetic resonance imaging of the brain showed acute infarct in the posterior limb of the right internal capsule. Troponin I was 0.04 ng/ml. Two-dimensional echocardiography showed anterolateral hypokinesis to akinesis with an ejection fraction of 35–40 %, suggesting anterolateral myocardial infarction. Cardiac catheterization showed that the left anterior descending artery (LAD) was a good-sized 3 mm vessel with clear evidence of localized spontaneous coronary dissection at the second diagonal branch involving the ostium of the second diagonal branch. A stent was placed in the localized area of spontaneous dissection in the mid-LAD area with no post-catheterization complications, restoring normal flow. This case represents a unique manifestation of spontaneous coronary artery dissection leading to myocardial infarction, resulting in clot formation in the akinetic left ventricle with possible embolization, leading to acute stroke. It also shows that a single stent at the origin of the coronary artery dissection is a good method of treating spontaneous coronary artery dissection.
Spontaneous coronary artery dissection (SCAD) is a rare and potentially life-threatening condition that can cause rapid deterioration and fatal myocardial infarction. By definition, SCAD implies formation of a false lumen around the true lumen of the artery, which may or may not communicate with the true lumen. By compression of the true lumen, this may cause a blockage of the coronary flow, resulting in myocardial infarction (MI). Early recognition is important as the dissection can progress unpredictably upstream or downstream. Potential associations have been made between this condition and female gender, pregnancy, cystic medial necrosis, cocaine abuse, and collagen vascular disorders. We present a case report of a relatively healthy individual with no significant past medical history who presented with stroke, with the work-up revealing MI from SCAD. The patient was treated successfully using percutaneous coronary intervention.
Case Description
A 60-year-old Caucasian male with no significant past medical history and no allergies was admitted with a complaint of left-sided numbness followed by weakness in
the left arm and leg. The patient was an active smoker who had smoked one pack per day for several years. His family history was negative for heart attack, stroke, diabetes, hypertension, or any other disorders, including collagen vascular diseases. The clinical impression was acute cerebrovascular accident within three hours. Computed tomography without contrast ruled out any bleed and the patient was given tissue plasminogen activator. Subsequent magnetic resonance imaging of the brain showed an acute infarct in the posterior limb of the right internal capsule, although magnetic resonance angiography was unrevealing. During his subsequent hospitalization, the patient regained power in his left upper and lower extremities.
Work-up was initiated to find the cause, including finding a possible hypercoaguable state. The patient did not complain of significant chest pain, but had an abnormal electrocardiogram with Q-waves in the anterolateral leads. Troponin I was 0.04 ng/ml. Two-dimensional echocardiography showed anterolateral hypokinesis to akinesis with an ejection fraction of 35–40 %, suggesting
• 1. Internal Medicine Resident; 2. Interventional Cardiologist, St Francis Medical Center, Trenton, NJ • Correspondence: Saad Tariq, MD, 210 Nottinghill Lane, Hamilton, NJ 08619. E:
tariqsaad_83@hotmail.com
Winter 2011 Spontaneous Coronary Artery Dissection Presenting with Stroke 125
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