Spontaneous coronary dissection presenting with reperfusion arrhythmia: A case report

• 作者: Frank C. McGeehin Ghazi Mirrani James F. Burke Joseph Kusick Khawar Maqsood Marwan Badri Muhammad R. Sardar Nosheen Sarwar Paul M. Coady Wajeeha Saeed
• 来源期刊: 临床医学病理报告(英文)
• 学科: 医学
• 关键词: SPONTANEOUS CORONARY DISSECTION ACCELERATED Idioventricular RHYTHM
• 年，卷（期）: 2013,（3）
• 页码范围: 215-218
• 页数: 4页
• 分类号: R5

摘要

Spontaneous coronary dissection is more commonly reported in females and is an important differential diagnosis for acute coronary syndrome. Accelerated idioventricular rhythm has been reported before with reperfusion post myocardial ischemia. We report a case of accelerated idioventricular rhythm in a patient with spontaneous coronary artery dissection. A 45-year-old Caucasian female presented with left sided chest pain radiating to the neck and palpitations. Admission ECG showed accelerated idioventricular rhythm. Troponin I peaked at 0.5 ng/ml. Coronary angiography showed mid to distal left anterior descending artery dissection with adequate distal flow. Patient was initially medically managed with aspirin, metoprolol, intravenous heparin and eptifibatide infusions but continued to have symptoms of unstable angina. She underwent successful percutaneous coronary intervention with 2 drug eluting stents and was discharged back home symptom free on dual platelet therapy. Spontaneous coronary artery dissection is an important differential diagnosis for acute coronary syndrome especially in younger females. Accelerated idioventricular rhythm can be a presentation of coronary dissection and may indicate instability. Early percutaneous coronary intervention should be considered in such patients.