Hereditary Spontaneous Coronary Artery Dissection
Journal Title: Journal of Case Reports and Studies - Year 2018, Vol 6, Issue 3
Abstract
Introduction: SCAD with an estimated prevalence of 1.7% to 4% is an important cause of Myocardial infarction especially in middleaged women with no or minimal cardiovascular risk factors. Diagnosis requires a high degree of suspicion and better coronary imaging. The hereditary/ genetic component has been postulated to play a role, but there is insufficient data on familial SCAD. We present a case of SCAD with probable genetic and autoimmune association. Case Description: A 42-year-old female with past medical history of asthma and Hashimoto's thyroiditis presented to Emergency Department with sudden onset of intense left-sided chest heaviness, precipitated by emotional stress in a courtroom. Her family history was significant for vasospastic angina in her mother at the age of 38 years. Coronary angiography of her mother was normal. On examination, she was in moderate distress due to chest pain. She was tachycardic and hypertensive at the time of presentation. Neck veins were not distended. Cardiac examination revealed tachycardia with normal heart sounds without any murmurs or gallops. Rest of the examination was unremarkable. Initial Electrocardiogram revealed sinus tachycardia with no ischemic changes. She received aspirin and Cardiac enzyme panel showed Troponin of 15.87 ng/mL (0.05-0.49 ng/mL) and CK-MB of 89 ng/mL (0-8 ng/mL). She experienced the recurrence of pain in the emergency department, and repeated EKG showed ST-segment elevation in inferior leads. Immediate coronary angiography revealed dissection of the first obtuse marginal vessel, confirmed by Intravascular ultrasound(IVUS). Due to the presence of unopposed hematoma, distal and proximal vessels were stented using two drug-eluting stents with the restoration of brisk blood flow. Left ventriculography demonstrated inferior wall hypo-kinesis with low normal left ventricular ejection fraction. The patient was discharged after four days of observation on Aspirin, Ticagrelor, Metoprolol, and Atorvastatin. Discussion: Diagnosis of SCAD is becoming more common due to increased awareness and better coronary imaging modalities. Our patient’s mother had normal coronary angiography, and her symptoms were attributed to vasospastic angina in an era when knowledge of SCAD was limited due to non-availability of advanced coronary imaging. Both patient and her mother had a similar presentation without any traditional cardiovascular risk factors which raises suspicion of the genetic/ hereditary component. Her mother had Addison's disease, and the patient had autoimmune thyroiditis which also raises suspicion of autoimmune association. A high index of suspicion is required for diagnosis which can be confirmed by coronary imaging. Stenting is usually not performed as these heal spontaneously. Hypertension has been linked with recurrent SCAD.
Authors and Affiliations
Kumar M
Keywords
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- EP ID EP584799
- DOI 10.15744/2348-9820.6.307
- Views 75
- Downloads 0
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Hereditary Spontaneous Coronary Artery Dissection
Introduction: SCAD with an estimated prevalence of 1.7% to 4% is an important cause of Myocardial infarction especially in middleaged women with no or minimal cardiovascular risk factors. Diagnosis requires a high degree...