title: Spontaneous Coronary Artery Dissection: The Phantom Menace.
abstract: We present a case of a 66-year-old lady with chest pain, without dynamic 12-lead electrocardiographic (ECG) changes and normal serial troponin. Coronary angiography revealed a linear filing defect in the first obtuse marginal branch of the circumflex artery indicating coronary artery dissection, with superadded thrombus. She was managed medically with dual antiplatelet therapy and has responded well. Spontaneous coronary artery dissection (SCAD) is a rare cause of cardiac chest pain, which can be missed without coronary angiography. Unlike most other lesions in patients with unstable symptoms, where coronary intervention with stenting is recommended, patients with SCAD generally fare better with conservative measures than with intervention, unless there is hemodynamic instability.
authors.affiliation: Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medicine, The University of Hertfordshire, UK.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Spinthakis
authors.affiliation: Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK.
authors.forename: Nada
authors.initials: N
authors.lastname: Abdulkareem
authors.affiliation: Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medicine, The University of Hertfordshire, UK.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Farag
authors.affiliation: Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medicine, The University of Hertfordshire, UK; National Heart & Lung Institute, Imperial College, London, UK.
authors.forename: Diana A
authors.initials: DA
authors.lastname: Gorog
keywords: Conservative measure; Coronary artery; Dissection; Phantom menace