Spontaneous Coronary Artery Dissection in a 26-Year-Old-Male Soldier

Military Medicine
Joel M GuessShaun Martinho

Abstract

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndromes, which has been gaining increased recognition with the routine use of coronary angiography and intravascular imaging techniques in patients presenting with ST-elevation myocardial infarction. Here we report the case of a healthy, 26-year-old active-duty male presented to Tripler Army Medical Center for evaluation of acute onset and worsening chest pain that occurred shortly after participating in an Army physical fitness test. His initial EKG demonstrated a myocardial injury pattern with ST elevations in leads V1-V4. Invasive angiography revealed thrombotic occlusion of the proximal left anterior descending coronary artery with no evidence of atherosclerotic disease by intravascular ultrasound imaging. SCAD was suspected, and this diagnosis was confirmed after eptifibatide-induced propagation of the dissection plane resulting in recurrence of his index chest pain. To our knowledge, this is the first reported case of SCAD in the active-duty military population. SCAD is a rare, but important, cause of acute coronary syndromes that must be recognized by military providers as it necessarily precludes further military service.

References

Apr 29, 2006·Journal of Cardiovascular Medicine·Turhan Kurum, Meryem Aktoz
May 8, 2010·Heart·Christian J M Vrints
Mar 4, 2014·European Heart Journal. Acute Cardiovascular Care·Tsuyoshi NishiguchiTakashi Akasaka
Aug 19, 2014·Circulation Journal : Official Journal of the Japanese Circulation Society·Fernando AlfonsoRajiv Gulati
Apr 23, 2016·JACC. Cardiovascular Interventions·Peter FahmyJacqueline Saw
Nov 1, 2016·Coronary Artery Disease·Fernando AlfonsoJacqueline Saw
Jul 16, 2016·Journal of the American College of Cardiology·Jacqueline SawKarin H Humphries

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