Too Young to Have a Broken Heart: Spontaneous Coronary Artery Dissection Causing ST-Elevation Myocardial Infarction in a Young Adult: A Case Report

Abstract

ST-elevation myocardial infarction (STEMI) rarely occurs among patients 18 to 34 years old. Spontaneous coronary artery dissection (SCAD) is a rare cause of STEMI and is frequently described among patients in peripartum period. SCAD has a high mortality rate if not recognized and treated immediately. We present a case of SCAD presenting as STEMI in a 19-year-old nonpregnant patient. A 19-year-old female with chronic kidney disease, complained of sudden onset substernal chest pain. Physical examination showed a blood pressure of 140/90 mm Hg, HR of 112 bpm, with note of rales, pedal edema, and cold clammy extremities. Electrocardiogram showed ST-elevation in leads V3 to V6. Cardiac troponin was elevated and echocardiography revealed left ventricular segmental hypokinesia and depressed systolic function. Patient was diagnosed with acute anterolateral wall STEMI. Coronary angiogram revealed total occlusion of the mid-segment of the left anterior descending artery (LAD), while the rest of the coronary arteries were strikingly normal. After initial balloon angioplasty and stenting of the mid LAD, coronary artery dissection was noted at the distal LAD. A stent was successfully deployed, achieving TIMI flow grade III with no residual stenosis. She remained stable and was discharged improved. STEMI rarely happens in the young adults. Moreover, literature highlights the rarity of STEMI caused by SCAD. SCAD usually occurs among young pregnant patients without risk factors for atherosclerosis. We highlighted the significance of suspecting SCAD among young patients who present with STEMI and prompt treatment with revascularization in clinical situations such as this case. SCAD remains to be a rare cause of STEMI. However, SCAD should be considered among young individuals with STEMI. Treatment is primarily medical unless there is persistent chest pain and/or ischemic ECG changes, hemodynamic instability, or unstable arrhythmia, where revascularization is necessary.




J Med Cases. 2018;9(6):164-169
doi: https://doi.org/10.14740/jmc3052e