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Case Reports
. 2021 Feb 1;97(2):E249-E252.
doi: 10.1002/ccd.28960. Epub 2020 May 7.

Spontaneous coronary artery dissection of the left anterior descending artery in a patient with COVID-19 infection

Kris Kumar  1 , Joshua C Vogt  1 , Punag H Divanji  1 , Joaquin E Cigarroa  1
Affiliations
Case Reports

Spontaneous coronary artery dissection of the left anterior descending artery in a patient with COVID-19 infection

Kris Kumar et al. Catheter Cardiovasc Interv. .

Abstract

A 48-year-old woman with a past medical history of migraines and hyperlipidemia presented due to severe retrosternal chest pain with no other associated signs or symptoms. The patient was hemodynamically stable and was found to have an elevated troponin with electrocardiogram showing no ischemic changes. Computed tomography of the coronary arteries showed a left dominant system with dissection extending from the mid-to-distal left anterior descending (LAD) artery. The patient was subsequently discharged on medical therapy but returned 3 days later due to worsening chest pain. Electrocardiogram revealed inferior and anteroseptal ST segment changes with peak troponin of 14.9 ng/ml (reference range <0.80 ng/ml). Coronavirus disease 2019 (COVID-19) nasopharyngeal swab was performed prior to urgent coronary angiogram. Coronary angiogram was performed with full personal protective equipment for respiratory and droplet precautions due to pending COVID-19 testing results. Angiogram revealed spontaneous coronary artery dissection (SCAD) extending from the ostium of the LAD to the distal vessel. COVID-19 testing returned positive while in intensive care unit. The patient was not a percutaneous coronary intervention candidate due to the extent of the dissection and was not a surgical candidate due to a lack of graftable target and medical management was continued. To our knowledge, this case is the first in which SCAD has been reported in the LAD in a patient with COVID-19 with no other symptoms of respiratory illness or symptoms classically associated with the novel coronavirus. SCAD should be considered on the differential as one of the various cardiac manifestations of COVID-19 infection.

Keywords: catheterization diagnostic; coronary angiography; coronary artery disease; coronary dissection.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Coronary computed tomography showing dissection of the left anterior descending (LAD) artery. (a) Patent left main coronary artery, proximal LAD, and left circumflex arteries (arrows). (b) Patent proximal to mid LAD artery (arrow). (c) Spontaneous coronary artery dissection of the mid LAD artery (arrow)
FIGURE 2
FIGURE 2
Electrocardiogram showing ST segment changes in the inferior and anteroseptal leads
FIGURE 3
FIGURE 3
Coronary angiography. (a) Dissection of the left anterior descending (LAD) artery extending from the ostium to the distal vessel. (b) Wraparound LAD artery supplying the inferior septum. (c) Seventy percent compression of the LAD artery from the mid to distal vessel
See this image and copyright information in PMC

References

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