Vol. 45 | No. 1 | January-June 2017 Back

Open Access

Spontaneous Coronary Artery Dissection Causing ST-Elevation Myocardial Infarction in a Young Adult: A Case Report

Marc Denver A. Tiongson, Eric Oliver D. Sison, Jaime Alfonso Aherrera, Justin Joseph Regalado, Dioscoro DC Bayani II, Joerelle Mojica,  Nashiba Daud, John Daniel Ramos
Jun 2017 DOI 10.69944/pjc.979b06cde5

Abstract

Introduction: ST-elevation myocardial infarction (STEMI) rarely occurs among patients 18 to 34 years old.  Spontaneous coronary artery dissection (SCAD) is a rare cause of STEMI that is frequently described  among patients in peripartum period. SCAD has a high mortality rate when not recognized and  treated immediately. We present a case of SCAD presenting as STEMI in a nineteen-year-old non pregnant patient. 

Case: A nineteen-year-old female with chronic kidney disease complained of sudden-onset substernal  chest pain. Physical examination showed blood pressure of 140/90 mmHg, heart rate of 112 beats  per minute, with findings of of bibasilar rales, pedal edema and cold and clammy extremities.  

Electrocardiogram (ECG) showed ST-elevation in leads V3 to V6. Cardiac troponin was elevated,  and echocardiography revealed left ventricular segmental hypokinesia and depressed systolic function.  Patient was diagnosed with acute anterolateral wall STEMI. Coronary angiogram revealed total  occlusion of the mid segment of the left anterior descending artery (LAD), while the rest of the  coronary arteries were strikingly normal. After initial balloon angioplasty and stenting of the mid LAD, coronary artery dissection was noted at the distal LAD. A stent was successfully deployed,  achieving thrombolysis-in-myocardial-infarction (TIMI) flow grade III with no residual stenosis.  Patient remained stable and was discharged improved. 

Discussion: STEMI rarely happens in young adults. Moreover, literature highlights the rarity of STEMI  caused by SCAD. SCAD usually occurs among young pregnant patients who have no risk factors  for atherosclerosis. In this report, we highlight the importance of suspecting SCAD among young  patients who present with STEMI and of prompt treatment with revascularization in similar clinical  situations. 

Conclusion: SCAD remains a rare cause of STEMI, but it should be considered when young individuals present  with STEMI. Treatment is primarily urgent revascularization especially if there is persistent chest  pain or ischemic ECG changes, hemodynamic instability, or unstable arrhythmia. 

Keywords: spontaneous coronary artery dissection, SCAD, acute coronary syndrome, ACS, ST-elevation myocardial  infarction, STEMI 

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