title: Spontaneous coronary artery dissection in a patient with bacterial meningitis.
abstract: A 40-year-old man was admitted to our hospital because of the acute onset of fever and headache, which were attributed to bacterial meningitis. Antibiotic treatment was initiated and his condition gradually improved. On day 5 after admission, immediately after masturbation, he developed abrupt onset of severe chest pain and cold sweat and the ECG suggested acute anterior myocardial infarction. Immediate coronary angiography revealed spontaneous dissection of the left anterior descending artery. After conservative management, his cardiac function improved. Acute coronary syndrome may be rarely caused by spontaneous coronary artery dissection. Sepsis was considered as a probable trigger for spontaneous coronary artery dissection, possibly through vascular damage from increased nitric oxide and sympathetic nervous over-activation.
authors.affiliation: Department of General Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Mito, Ibaraki, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kinoshita
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tsunoda
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Watanabe
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017023:Coronary Angiography / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000628:therapy; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000379:methods; D004554:Electric Countershock; D004562:Electrocardiography / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D018570:Risk Assessment; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014652:Vascular Diseases / Q000151:congenital* / Q000000981:diagnostic imaging / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents