Spontaneous Coronary Artery Dissection Presenting as Electrical Storm: A Case Report.

Introduction: Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in patients of younger age without typical atherosclerotic risk factors and can present with ventricular arrhythmia such as ventricular tachycardia (VT) or ventricular fibrillation (VF). Electrical storm (ES) is defined as greater than or equal to 3 episodes of VT or VF occurring within 24 hours. Case Report: A healthy 38-year-old-male developed chest pain while exercising at the gym and presented to the emergency department unresponsive in a ventricular arrhythmia defined as ES. The patient's cardiac arrest was initially refractory to standard defibrillation and Advanced Cardiac Life Support medications. He was ultimately diagnosed with SCAD of the left anterior descending artery, which was stented. The patient survived neurologically intact after a 13-day hospital stay. Conclusion: Spontaneous coronary artery dissection is a significant cause of acute coronary syndrome and occurs in healthier patients without cardiac risk factors. Electrical storm represents a unique manifestation of SCAD. Emergency physicians should maintain a heightened suspicion for SCAD for accurate diagnosis and treatment.

Carotid Artery Dissection as a Result of Penetrating Ear Trauma.

CASE PRESENTATION: Here we present the case of a previously healthy 67-year-old female with carotid artery dissection as a result of penetrating ear trauma. DISCUSSION: Carotid artery dissection can result from unusual mechanisms of injury and present without typical symptoms or exam findings. If left untreated, devastating neurologic sequela can occur. Physicians must have a low threshold to obtain vascular imaging to appropriately manage such cases.

Dead Legs: A Case of Bilateral Leg Paralysis.

Aortoiliac occlusive disease (AOD) is a rare presentation of thrombosis of the abdominal aorta. Also known as Leriche syndrome, its classic description entails claudication of the buttocks, thighs, and calves, absent femoral pulses, and impotence. AOD risk factors include smoking, hypertension, hyperlipidemia, diabetes, chronic renal insufficiency, and hypercoagulopathy. Ischemic complications of gastrointestinal malperfusion, renal infarction, and paralysis secondary to spinal cord ischemia are also noted. This case describes AOD complicated by a Stanford Type B aortic dissection leading to multi-system organ failure. A brief review of the literature further elucidates the key risk factors in identifying and treating Leriche syndrome.