A Case of Acute Myocardial Infarction Associated with Spontaneous Coronary Artery Dissection

ABSTRACT

A spontaneous coronary artery dissection is a rare cause of acute myocardial ischemia. However, its precise etiology, pathogenesis, prevalence and treatment is unclear. The clinical presentation of a spontaneous coronary artery dissection can be sudden death or an acute coronary syndrome and sometimes no symptoms are present. We report a case of a 39-year-old man with a spontaneous coronary artery dissection in the right coronary artery. He presented with a history of chest pain persisting for 4 hours. The initial electrocardiogram showed a ST segment elevation in lead II III and aVF. He received intravenous urokinase, but no improvement in his symptoms was observed and the electrocardiographic changes did not resolve. A rescue coronary angiogram was performed, which demonstrated an area of dissection in the distal right coronary artery with resultant TIMI II flow. A 3.5x36 mm MAC stent was deployed across the lesion. After implanting the stent, the remainder of his stay was uncomplicated and he has remained asymptomatic at the time of this review.