A Rare Case of Triple Vessel Spontaneous Coronary Artery Dissection
Author: Raghuram Chava, MD, Additional Authors**
Introduction/Objective:
Spontaneous coronary artery dissection (SCAD) is an infrequent overall cause for ACS and the vast majority of reported cases are limited to a single vessel (84%) or two vessels (15%). We report the rare case of a young female patient with triple vessel SCAD.
Case Presentation:
22 y/o woman, 2 weeks postpartum after her 4th pregnancy presented to emergency room with anginal chest pain. She did not have any known risk factors for atherosclerotic coronary artery disease. EKG showed ST depressions in inferior & lateral leads and Troponin was elevated to peak value of 4.932 (Normal Troponin I <0.040 ng/ml). Echocardiogram was consistent with mild decrease in LVEF (50%) without any focal wall motion abnormalities. Her coronary angiography revealed triple vessel SCAD involving distal LM extending to mid LAD, LCX and distal RCA. Further workup with CTA of the head/neck/abdomen revealed diffuse irregularity of vertebral arteries and intra cranial arteries, irregular caliber & focal wall thickening of common iliac arteries, and ectasia of the infrarenal abdominal aorta consistent with the diagnosis of Fibromuscular dysplasia (FMD). She was hemodynamically stable throughout, was managed conservatively with heparin during hospitalization, and was discharged home after 10 days on aspirin, Plavix, Metoprolol and Captopril.
Discussion:
Postpartum SCAD is a known cause of ACS in young females and SCAD has been reported to be a cardiac manifestation in patients with FMD. But majority of SCAD reported in literature is limited to a single vessel disease. Two vessel involvements are thought be quite rare, and multivessel involvement even rarer. Due to the limited number of cases, there is limited prognostic data, and or a standardized treatment plan. The case reported here highlights that multivessel extensive SCAD is possible, and that in young patients without significant risk factors for coronary disease, the clinical strategy might warrant a high clinical suspicion of SCAD, early invasive angiography, and non-invasive imaging to evaluate for FMD.
Conclusion:
Multivessel SCAD can occur, especially in FMD patients who are postpartum. Prospective and retrospective studies are needed to optimized treatment strategies and prognosis of these patients.
**Additional Authors
Raghuram Chava, MD, Heart and Vascular, MetroHealth Medical Center
Enrique Soltero Mariscal, MD, Heart and Vascular, MetroHealth Medical Center
Sunil Vasireddi, MD, Heart and Vascular, MetroHealth Medical Center
Ashish Aneja, MD, Heart and Vascular, MetroHealth Medical Center
Sanjay Gandhi, MD, Heart and Vascular, MetroHealth Medical Center
Fellowship Director: Meera Kondapaneni, MD, FACC
Fellowship Coordinator: Brittany Markle
