Shenoy Padma, Tayeb Taher, Covas Pedro, Temesgen Nardos, Tracy Cynthia
The George Washington University Hospital, Washington, DC, USA.
Case Rep Cardiol. 2020 Oct 13;2020:8882561. doi: 10.1155/2020/8882561. eCollection 2020.
A 19-year-old healthy male collegiate athlete presented with typical anginal symptoms after running a 5K race. He had complained of similar symptoms off and on for the past month. On presentation, troponin was 0.12 ng/ml (reference value < 0.01 ng/ml), which peaked at 17.7 ng/ml and CK-MB was 28.71 IU/L (reference value < 25 IU/L). ECG showed diffuse biphasic T-waves. Coronary computed tomography angiogram (cCTA) demonstrated a 1.5 cm dissection in the left anterior descending artery and a 1.9 × 1.8 cm attenuation defect in the left ventricular apex consistent with thrombus. Subsequent coronary catheterization confirmed dissection of the left anterior descending artery. Spontaneous coronary artery dissection (SCAD) is a rare phenomenon. Diagnosis can be made through noninvasive measures but is usually done through left heart catheterization. In young patients who present with an NSTEMI, clinical suspicion for SCAD among other conditions should be raised. Additionally, recognizing that complications such as intracardiac thrombi can occur in SCAD is critical in ensuring appropriate therapy.
一名19岁健康的男性大学生运动员在跑完5公里比赛后出现典型的心绞痛症状。在过去的一个月里，他断断续续地抱怨过类似症状。就诊时，肌钙蛋白为0.12纳克/毫升（参考值<0.01纳克/毫升），峰值为17.7纳克/毫升，肌酸激酶同工酶（CK-MB）为28.71国际单位/升（参考值<25国际单位/升）。心电图显示广泛的双相T波。冠状动脉计算机断层扫描血管造影（cCTA）显示左前降支有1.5厘米的夹层，左心室尖有一个1.9×1.8厘米的衰减缺损，符合血栓表现。随后的冠状动脉导管检查证实了左前降支夹层。自发性冠状动脉夹层（SCAD）是一种罕见现象。诊断可通过非侵入性措施进行，但通常通过左心导管检查完成。对于出现非ST段抬高型心肌梗死（NSTEMI）的年轻患者，应提高对SCAD及其他疾病的临床怀疑。此外，认识到SCAD可能发生心内血栓等并发症对于确保适当治疗至关重要。
