title: Spontaneous coronary artery dissection in an elderly woman presenting with chest pain and positive cardiac biomarkers.
abstract: A 68-year-old African American female with a prior medical history of hypertension and dyslipidemia presented with sudden onset pressure-like substernal chest pain. Initial ECG showed no ST or T wave abnormalities, and troponin elevation of 2.88 ng/mL. Two hours later, chest pain recurred with ECG change and increase in troponin to 11.97 ng/mL. She underwent urgent coronary angiography, which revealed left anterior descending artery dissection with thrombus. We successfully treated with balloon angioplasty followed by placement of 3 drug-eluting stents resulting in TIMI-3 flow; further testing for vasculitis was negative. Once spontaneous coronary artery dissection is diagnosed, the approach to treatment is controversial and treatment should be patient tailored.
authors.affiliation: Henry Ford Hospital, Department of Internal Medicine, Division of Cardiovascular Disease, Detroit, Michigan 48202, USA.
authors.forename: Mohanad A
authors.initials: MA
authors.lastname: Alfaqih
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Michel Ortega
authors.forename: Eric H
authors.initials: EH
authors.lastname: Yang
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers; D002637:Chest Pain / Q000175:diagnosis* / Q000628:therapy; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000628:therapy
chemical_list: D015415:Biomarkers