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PATIENT CHARACTERIZATION
A previously healthy 48-year-old male farmer was admitted to the emergency room complaining of anterior chest pain described as "tearing", which started after extreme physical exertion, co-occurring with general malaise and lipothymia.
He denied having previous comorbidities such as hypertension, diabetes, family history of cardiovascular disease and smoking or alcohol consumption.
Anterior wall ST-segment depression was observed in the electrocardiogram and troponin levels were increased.
The patient then underwent coronary catheterization. Angiography showed a tortuous left anterior descending (LAD) coronary artery with a dissection line involving proximal and middle segments, resulting in mild to moderate luminal stenosis; these findings were consistent with spontaneous coronary artery dissection (SCAD) diagnosis (Figure 1).
Fig. 1 Spontaneous coronary artery dissection affecting the left anterior descending coronary artery. (A) Characteristic angiographic flap is visualized. (B) Long lesion is visualized. (C) Arrows pointing the initial and final dissection points.
SCAD is a spontaneous separation between the layers of a coronary artery wall, non-iatrogenic or trauma related[1], which has some predisposing factors, namely: fibromuscular dysplasia, postpartum status, multiparity, connective tissue disorders, systemic inflammatory conditions and hormonal therapy[2-4].
SCAD is responsible for 0.1% to 0.4% of all acute coronary syndrome (ACS) cases in general population[5,6], and up to a quarter of them in women ≤50 years old[7].
Emotional and physical stressors were identified as common triggers in the Vancouver General Hospital SCAD registry. Out of 204 cases, 99 (48.5%) of them reported emotional stressors and 87 (42.6%) of them physical stressors...