title: Recurrent chest pain after treatment of spontaneous coronary artery dissection: An enigma.
abstract: Spontaneous coronary artery dissection (SCAD) is a rare entity. It has been described in various settings like pregnancy, collagen vascular diseases, cocaine abuse, heavy exercise, variant angina, eosinophilic arteritis, or fibro muscular dysplasia. It is also easy to miss a dissection during angiography, as the typical radiolucent lumen seen in coronary angiography may be absent in many cases. In this report, we describe the case of a 35-year-old female who presented with acute ST elevation myocardial infarction due to spontaneous coronary dissection. She had been having episodic chest pain for one year and had been seen by two different cardiologists but was thought to have non-cardiac symptoms. Even during the index hospitalization, she underwent coronary angiography three times before coronary dissection could be identified as the cause of her symptoms. She underwent coronary artery bypass graft surgery uneventfully. However, even after myocardial revascularization, she has had multiple episodes of chest pain requiring hospitalization. However, we have not been able to find a specific cause for it and the cause of her recurrent chest pain remains an enigma. This case highlights the problems, which arise while managing a case of SCAD. More research is needed to find the exact etiology and long-term prognosis of this condition.
authors.affiliation: Fortis Rajan Dhall Hospital, Sector B, Pocket 1, Vasant Kunj, New Delhi 110070, India.
authors.forename: Dheeraj D
authors.initials: DD
authors.lastname: Bhatt
authors.affiliation: Fortis Rajan Dhall Hospital, Sector B, Pocket 1, Vasant Kunj, New Delhi 110070, India.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Kachru
authors.affiliation: Fortis Rajan Dhall Hospital, Sector B, Pocket 1, Vasant Kunj, New Delhi 110070, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Executive Director and Dean, Fortis Rajan Dhall Hospital, Sector B, Pocket 1, Vasant Kunj, New Delhi 110070, India. Electronic address: kaul.upendra@gmail.com.
authors.forename: Upendra
authors.initials: U
authors.lastname: Kaul
mesh_terms: D000328:Adult; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000601:surgery; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000601:surgery; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D012008:Recurrence; D014652:Vascular Diseases / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Coronary artery disease; Coronary spasm; Spontaneous coronary artery dissection