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Case Reports
. 2011 Mar 3:6:22.
doi: 10.1186/1749-8090-6-22.

Spontaneous coronary artery dissection in a young man - case report

Julia Schmid  1 , Johann Auer
Affiliations
Case Reports

Spontaneous coronary artery dissection in a young man - case report

Julia Schmid et al. J Cardiothorac Surg. .

Abstract

A 31 year old man with a 17-year-history of drug abuse (heroine and cannabis) was admitted with recurrent chest pain over a period of about three weeks. Chest discomfort severely worsened during the 5 hours before hospital admission. Electrocardiography revealed poor R-wave progression and non specific repolarization abnormalities. Echocardiography showed extensive left ventricular anterior and apical wall motion abnormalities and a ventricular thrombus located at the apex of the left ventricle was present. Subsequently, a diagnosis of acute coronary syndrome was made. Coronary angiography revealed spontaneous coronary artery dissection of the left anterior descending (LAD) artery with Thrombolysis In Myocardial Infarction (TIMI) flow 2 to 3. We managed the patient conservatively. The clinical course was uneventful and repeated angiography on day 4 demonstrated spontaneous healing of large parts of the dissection with TIMI 3 flow in the LAD.

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Figures

Figure 1
Figure 1
Electrocardiogram at admission with poor R-wave progression and non specific repolarization abnormalities.
Figure 2
Figure 2
Transthoracic echocardiography; 4 chamber view reveals left ventricular thrombus.
Figure 3
Figure 3
Coronary angiography in RAO view with dissection of the left anterior descending artery.
Figure 4
Figure 4
Coronary angiography in posterior-anterior view with caudal angulation with dissection of the LAD.
Figure 5
Figure 5
Coronary angiography in LAO view with dissection of the left anterior descending artery.
Figure 6
Figure 6
Coronary angiography in RAO view 5 days after admission with dissection of the LAD.
See this image and copyright information in PMC

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