Spontaneous coronary artery dissection
Journal Title: Nepalese Heart Journal - Year 2012, Vol 9, Issue 1
Abstract
A 38 year old previously healthy woman was referred to ER for ongoing chest pain. She had sudden onset of central, crushing chest pain 3 h back and her ECG was found to have evidence of acute infero-lateral wall MI. There was no history of cardiovascular disease or identfable CAD risk factors. She had a history of bone TB 10 y back. She was on oral contraceptve pills 5 y back. Her mother had hypertension and diabetes mellitus. Her father died at the age of 75 y due to unknown cause and had a history of hypertension. There is no history of hypertension, diabetes mellitus or CVD in her siblings. General Examinaton: O2 saturaton-95%, Pulse-88bpm, Bp-110/90mmHg.Systemic Examinaton: no abnormality detected. Investgaton: CBC, RFT, BSR, and Electrolytes were WNL. ECG: ST elevaton in infero-lateral leads 3 h back but minimal ST elevaton in lll and AVF in our ER. Cardiac Biomarkers: CPK-MB-50u/l and Trop + .Echo screening: hypokinetc apex, apical IVS and apical inferior LV wall. She was diagnosed as acute infero-lateral wall MI and was admited in CCU was treated with Aspirin, Clopidogrel ,LMWH ,Atorvastatn ,IV GTN , Beta-Blocker, Anxiolytcs ,PPI and Stool sofener .She was well on frst post MI day but suddenly developed chest pain on second post MI day and her ECG showed ST elevaton in V3-V6. She was taken to Cath lab for rescue PCI. Her coronary angiography studies revealed a linear dissecton involving the distal LAD with TIMI 3 distal flow (Fig1). She was conservatvely management and was discharged on 7 post MI day.
Authors and Affiliations
Sharma Ranjit| Department of cardiology, Shahid Gangalal Natonal Heart centre, Kathmandu, Bansbari, Rajbhandari Rajeeb| Department of cardiology, Shahid Gangalal Natonal Heart centre, Kathmandu, Bansbari, Limbu Yubraj| Department of cardiology, Shahid Gangalal Natonal Heart centre, Kathmandu, Bansbari, Singh Satsh| Department of cardiology, Shahid Gangalal Natonal Heart centre, Kathmandu, Bansbari, Bhat YKD| Department of cardiology, Shahid Gangalal Natonal Heart centre, Kathmandu, Bansbari, K. C Man Bahadur| Department of cardiology, Shahid Gangalal Natonal Heart centre, Kathmandu, Bansbari
Keywords
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- EP ID EP15718
- DOI http://dx.doi.org/10.3126/njh.v9i1.8352
- Views 377
- Downloads 16
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