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Colegio de Medicina Interna de México.

2021, Number 1

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Med Int Mex 2021; 37 (1)

Spontaneous dissection of the anterior descending artery

Schossler-Loss F, Alcirley-de Almeida L, Hidalgo-Aranda JA

Language: Spanish
References: 17
Page: 122-127
PDF size: 293.48 Kb.


ABSTRACT

Background: Coronary dissection results from the separation of the layers of the arterial wall by primary or secondary cause, being associated with the female gender of middle age, peripartum period, extreme physical exercise, thoracic trauma, systemic inflammatory diseases and use of illicit drugs. Clinically it can generate chest pain, syncope, dyspnea, ventricular arrhythmias, cardiogenic shock until sudden death. Cardiac enzymes are usually elevated, but the diagnosis is confirmed by coronary angiography associated with optical coherence tomography or by intravascular ultrasonography.
Clinical case: A female 31-year-old patient who presented with typical angina after physical activity and was admitted to the emergency department with acute coronary syndrome without ST-segment elevation. Cardiac catheterization showed spontaneous dissection in the proximal portion of the anterior descending artery with obstruction of 30% of vessel lumen, being chosen conservative treatment. After two years, she presented an ischemic cerebrovascular accident in the territory of the middle cerebral artery. The possible etiologies were the presence of patent foramen ovale and evidence of apical akinesia of the left ventricle, with patent foramen ovale closure and anticoagulation was initiated.
Conclusions: Spontaneous coronary dissection is a relatively rare type of coronary disease; it manifests as an acute coronary syndrome and should be suspected especially in young female patients with compatible clinical symptoms.


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