NAVIGATING ACUTE MYOCARDIAL INFARCTION: INSIGHTS FROM A CASE OF SPONTANEOUS CORONARY DISSECTION
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Keywords
Coronary artery, Cardiac, Acute coronary syndrome, coronary artery disease, and spontaneous coronary dissection
Abstract
Introduction: Acute myocardial infarction (AMI) rarely occurs due to spontaneous coronary dissection (SCD), predominantly affecting young to middle-aged adults without traditional cardiovascular risk factors. Clinical presentations range from pericardial tamponade to sudden death, with ventricular arrhythmias and chest discomfort being common manifestations.
Case Presentation: We present a case of a patient experiencing ST-elevation acute coronary syndrome (STEACS) precipitated by SCD during physical exercise, resulting in cardiac arrest. This highlights the importance of recognizing SCD as a potential cause of AMI, particularly in atypical patient demographics.
Discussion: Predisposing factors for SCD include fibromuscular dysplasia, connective tissue disorders (such as vascular Ehlers-Danlos syndrome and Marfan syndrome), female sex, pregnancy, age <50, and hormone therapy. Triggers such as weightlifting, extreme isometric training, and emotional stress have been identified. Coronary angiography remains the preferred diagnostic modality.
Conclusion: Conservative management may be preferable over revascularization in stable patients with SCD-associated AMI. Clinicians should be vigilant for SCD in young to middle-aged patients presenting with AMI, especially in the context of physical exertion. Early recognition and appropriate management are crucial for optimizing outcomes in such cases.
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Muhammad Rizwan Akram
Bronx care Health System, Department of Internal Medicine, Bronx, New York, USA,
Muhammad Nowsherwan Kundi
Doctor, Khyber Medical College, Pakistan
Megha Ganatra
St. George's University, School of Medicine, USA
Dr. Humayun Bin Irfan
Consultant physician and Cardiologist, Department of Medicine, Bahria International Hospital Bahria Town Karachi, Pakistan
Mohamad A. Khedari
Doctor, Md Department of Internal Medicine, USA
Amgad Samir Abdelmageed Mohamed Elfeki
Internal Medicine Resident in Egyptian Board 3rd Year, Department of Internal Medicine, Graduated From Cairo University, Egypt
Ahmed Samir Abdelmageed Mohamed Elfiki
Internal Medicine Specialist and Resident in Egyptian Board 3rd Year, Department of Internal Medicine, Graduated From Cairo University, Master degree in Shams university, Egypt,
Ángela Tatiana Pabón Benavides
Fundación Universitaria Sanitas, Department of Anesthesia, Colombia,