Journal Article

Case Report on Spontaneous Coronary Artery Dissection: A Rare Culprit of Chest Pain

Khudair, Aiman D, Narayana, Chetan, Sulaibeekh, Leena, Al-Rawahia, Thuraiya H, Marshall, Rachel A, Khudair, Ahmed D

2023

Overview

Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic separation of the coronary artery wall with subsequent intramural hematoma (IMH) formation in the false lumen. It can be associated with or without an intimal tear. It is clinically divided into three types based on its angiographic appearance. Most SCAD cases are seen in young or middle-aged women, especially in a peripartum state. Additionally, SCAD patients usually have fewer cardiovascular risk factors and more commonly have predisposing conditions like fibromuscular dysplasia (FMD). Patients present with features of chest pain that radiates to the left arm or neck, shortness of breath (SOB), as well as nausea and vomiting. Coronary angiography is the most widely used first-line modality to diagnose this condition. Management is usually conservative; however, invasive procedures can be utilized for high-risk patients. We present a case of a 54-year-old woman with SCAD diagnosed using coronary angiography and treated conservatively with dual-antiplatelet therapy, culminating with resolution.Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic separation of the coronary artery wall with subsequent intramural hematoma (IMH) formation in the false lumen. It can be associated with or without an intimal tear. It is clinically divided into three types based on its angiographic appearance. Most SCAD cases are seen in young or middle-aged women, especially in a peripartum state. Additionally, SCAD patients usually have fewer cardiovascular risk factors and more commonly have predisposing conditions like fibromuscular dysplasia (FMD). Patients present with features of chest pain that radiates to the left arm or neck, shortness of breath (SOB), as well as nausea and vomiting. Coronary angiography is the most widely used first-line modality to diagnose this condition. Management is usually conservative; however, invasive procedures can be utilized for high-risk patients. We present a case of a 54-year-old woman with SCAD diagnosed using coronary angiography and treated conservatively with dual-antiplatelet therapy, culminating with resolution.