Pothiawala Sohil, Lateef Fatimah
Department of Emergency Medicine, Singapore General Hospital, Singapore.
J Emerg Med. 2013 Jan;44(1):92-5. doi: 10.1016/j.jemermed.2011.08.024. Epub 2012 May 4.
Spontaneous coronary artery dissection (SCAD) is an extremely rare cause of acute coronary syndrome (ACS). Patients may present with a broad spectrum of clinical scenarios, ranging from angina pectoris to myocardial infarction, cardiogenic shock, and sudden death. Standard therapy has not been established; current treatments range from conservative management to percutaneous revascularization or coronary artery bypass surgery.
SCAD greatly mimics ACS, and this diagnosis should be considered when evaluating young patients who present with ACS with or without classical risk factors for coronary artery disease.
We report a case of a 45-year old man who presented with chest pain typical of ACS. He had no risk factors except for a smoking history of 2.5 pack-years. Once the clinical findings suggested acute inferolateral myocardial infarction, the patient underwent emergent cardiac catheterization, which revealed left anterior descending coronary artery dissection. This in itself is not a common cause of inferolateral ST elevation changes on electrocardiogram.
This case highlights the fact that although SCAD is a rare entity, it is increasingly being recognized as a significant cause of ACS. Urgent angiography should be considered if SCAD is suspected, because early diagnosis and appropriate management significantly improve the outcome in these patients.
自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征（ACS）极为罕见的病因。患者可能呈现出广泛的临床症状，从心绞痛到心肌梗死、心源性休克及猝死不等。尚未确立标准治疗方法；目前的治疗手段从保守治疗到经皮血管重建术或冠状动脉旁路移植术。
SCAD极易与ACS相混淆，在评估有或无冠状动脉疾病经典危险因素且表现为ACS的年轻患者时应考虑这一诊断。
我们报告一例45岁男性患者，其表现出典型的ACS胸痛症状。除了有2.5包年的吸烟史外，他没有其他危险因素。一旦临床检查结果提示急性下侧壁心肌梗死，该患者便接受了紧急心脏导管插入术，结果显示左前降支冠状动脉夹层。这本身并非心电图下侧壁ST段抬高改变的常见原因。
该病例凸显了这样一个事实，即尽管SCAD是一种罕见病症，但它正日益被视为ACS的一个重要病因。如果怀疑是SCAD，应考虑紧急血管造影，因为早期诊断和恰当治疗可显著改善这些患者的预后。
