Phogat Vishal, Nepal Subash, Kozman Hani
Internal Medicine, Upstate University Hospital, Syracuse, USA.
Cardiology, Upstate University Hospital, Syracuse, USA.
Cureus. 2022 May 29;14(5):e25459. doi: 10.7759/cureus.25459. eCollection 2022 May.
Due to limited understanding and knowledge of spontaneous coronary artery dissection (SCAD), it is typically believed to affect young peripartum women. We present a case of a post-menopausal older woman who suffered an acute non-ST segment elevation myocardial infarction (NSTEMI), secondary to a SCAD of the right posterior descending artery (PDA), after strenuous exercise. As the patient was hemodynamically stable and without signs of ongoing ischemia, she was managed conservatively. SCAD should be in differentials for patients presenting with acute coronary syndrome (ACS) who have no or few cardiovascular atherosclerotic risk factors. SCAD can be missed due to low suspicion of ACS in young and healthy patients. ACS from SCAD is often misdiagnosed and/or mismanaged as atherosclerotic ACS. Increasing awareness about this condition can lead to earlier diagnosis and prevention of sudden cardiac deaths. As most cases of SCAD can be managed conservatively, differentiating it from atherosclerotic ACS can reduce unnecessary reperfusion procedures and complications thereof.
由于对自发性冠状动脉夹层（SCAD）的认识和了解有限，通常认为它会影响年轻的围产期女性。我们报告一例绝经后老年女性病例，该患者在剧烈运动后因右冠状动脉后降支（PDA）发生SCAD，继发急性非ST段抬高型心肌梗死（NSTEMI）。由于患者血流动力学稳定且无持续缺血迹象，故对其进行了保守治疗。对于无或仅有少量心血管动脉粥样硬化危险因素且表现为急性冠状动脉综合征（ACS）的患者，SCAD应列入鉴别诊断范围。由于对年轻健康患者的ACS怀疑度较低，SCAD可能会被漏诊。由SCAD引起的ACS常被误诊和/或处理不当，被当作动脉粥样硬化性ACS。提高对这种疾病的认识可导致早期诊断并预防心源性猝死。由于大多数SCAD病例可采用保守治疗，将其与动脉粥样硬化性ACS区分开来可减少不必要的再灌注治疗及其并发症。
