Spontaneous Coronary Artery Dissection in the Setting of COVID-19 Pandemic-Related Stressors: A Case Report

Abstract

Spontaneous coronary artery dissection (SCAD) is an uncommon but important cause of acute myocardial infarction, particularly in younger women and in patients with underlying fibromuscular dysplasia (FMD). There is increasing literature on patients with SCAD reporting significant emotional stress, particularly stress related to unemployment, in the week prior to their cardiac event, and emotional triggers appear to be associated with worse in-hospital and follow-up cardiac events. Additionally, the COVID-19 pandemic has resulted in significant societal stressors and increased unemployment, which have been associated with increased cardiovascular morbidity. Here, we present a case of a female presenting with an acute MI secondary to SCAD in the setting of recently learning of impending unemployment due to COVID-19 vaccine refusal. This case highlights the importance of considering SCAD in patients with significant recent emotional stress who present with MI. Additionally, in light of the emotional stressors of the COVID-19 pandemic, clinicians must be aware of the consequences significant emotional stress plays on the development of adverse complications of chronic disease.

Keywords: acute st-elevation myocardial infarction; coronary fibromuscular dysplasia; covid 19; covid-19 vaccine; spontaneous coronary artery dissection; vaccine hesitancy.

Figure 1. (Left) Initial EKG showing borderline ST elevations in anterior leads. (Right) Subsequent EKG showing accelerated interventricular rhythm.

Figure 2. (A) Left anterior oblique cranial view of left coronary system. (B) Right anterior oblique cranial view of left coronary system. Note abrupt taper of mid LAD with small caliber vessel to the apex (arrows)

Figure 3. Transthoracic echocardiogram

Apical 2 chamber view during diastole (A) and systole (B). Note apical anterior and apical inferior wall motion abnormalities.

Figure 4. Neck CT angiogram shows coronal maximal intensity projection. Note the irregular beaded narrowing of the mid to distal cervical right ICA consistent with fibromuscular dysplasia.