Tan Elena, Radhakrishna Avinash, Curtin Ronan, Doyle Deirdre
Cardiology Department, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland.
Radiology Department, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland.
Radiol Case Rep. 2025 Jun 3;20(9):4156-4161. doi: 10.1016/j.radcr.2025.05.009. eCollection 2025 Sep.
We describe a case of a 38-year-old woman who presented with acute pleuritic chest pain following 3 days of emesis. There was a significant rise in troponin-I, consistent with a non-ST-segment elevation myocardial infarction (NSTEMI). Coronary angiography demonstrated a probable spontaneous coronary artery dissection (SCAD) with intramural haematoma of the left anterior descending (LAD) artery. The procedure was also complicated by an iatrogenic dissection of the right coronary artery (RCA), necessitating emergency stenting. The LAD dissection was managed conservatively. One month later, she represented to hospital with ongoing chest pain and mildly elevated troponin-I. Repeat coronary angiography revealed severe narrowing of the proximal LAD with a dissection flap and intramural dye staining in the proximal left circumflex (LCx) artery. Following multidisciplinary discussions, the patient was managed conservatively with medical management consisting of a beta-blocker, long-acting nitrate and single antiplatelet therapy. She was closely monitored with serial computed tomography coronary angiography (CTCA). Further investigations for underlying connective tissue disorders and fibromuscular dysplasia were unremarkable.
我们描述了一例38岁女性患者，在呕吐3天后出现急性胸膜炎性胸痛。肌钙蛋白I显著升高，符合非ST段抬高型心肌梗死（NSTEMI）。冠状动脉造影显示可能为自发性冠状动脉夹层（SCAD），伴有左前降支（LAD）动脉壁内血肿。该手术还因右冠状动脉（RCA）医源性夹层而复杂化，需要紧急置入支架。LAD夹层采用保守治疗。一个月后，她因持续胸痛和肌钙蛋白I轻度升高再次入院。重复冠状动脉造影显示LAD近端严重狭窄，伴有夹层瓣，左回旋支（LCx）动脉近端有壁内造影剂染色。经过多学科讨论，患者采用β受体阻滞剂、长效硝酸盐和单一抗血小板治疗的药物保守治疗。通过连续计算机断层扫描冠状动脉造影（CTCA）对她进行密切监测。对潜在结缔组织疾病和纤维肌发育异常的进一步检查无异常。
