RT Book, Section
A1 Tweet, Marysia
A1 Hayes, Sharonne N.
A2 Baliga, R. R.
A2 Lilly, Scott M.
A2 Abraham, William T.
SR Print(0)
ID 1160206985
T1 Spontaneous Coronary Artery Dissection
T2 Color Atlas and Synopsis of Interventional Cardiology
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071749350
LK accesscardiology.mhmedical.com/content.aspx?aid=1160206985
RD 2025/01/23
AB A  38-year-old  woman  arrived  at  the  emergency  department  by  private  car  complaining  of  substernal  chest  pain  and  nausea.  Symptoms  were  relieved  after  administration  of  2  sublingual  nitroglycerin  tablets.  Electrocardiogram  (ECG)  demonstrated  nonspecific  T-wave  changes,  and  initial  troponin  level  was  normal.  Physical  examination  and  chest  x-ray  were  unremarkable.  She  was  admitted  for  observation.  Her  second  troponin  level  was  elevated,  and  an  echocardiogram  showed  anterior  wall  hypokinesis  consistent  with  non–ST-segment  elevation  myocardial  infarction  (NSTEMI).  She  does  not  have  diabetes,  hypertension,  or  hyperlipidemia  and  has  no  family  history  of  premature  myocardial  infarction.  Coronary  angiography  showed  narrowing  in  the  left  anterior  descending  coronary  artery  (Figure  19-1).  Intravascular  optical  coherence  tomography  (OCT)  confirmed  intramural  hematoma  consistent  with  spontaneous  coronary  artery  dissection  (SCAD)  (Figure  19-2).  SCAD  is  nonatherosclerotic  disruption  and/or  intramural  hematoma  of  the  coronary  artery  wall  that  can  obstruct  coronary  blood  flow  and  cause  myocardial  ischemia  and/or  infarct.  Since  the  patient  was  pain  free  and  hemodynamically  stable,  no  intervention  was  performed.  She  was  treated  with  baby  aspirin,  β-blockade,  and  low-dose  nitrates.  She  had  an  uncomplicated  hospital  course  and  was  dismissed  after  monitoring  for  5  days.