title: Recurrent STEMI caused by multivessel spontaneous coronary dissection.
abstract: We present a case of a 52 year old female who suffered from a sudden syncope. A coronariography was performed and spontaneous coronary dissection was diagnosed in the posterior descending artery after an optical coherence tomography (OCT) was performed. A conservative management was decided. During hospitalization the patient presented with an episode of chest pain with an anterior ST elevation on ECG. Coronariography showed total occlusion of the left descending artery and again a dissection was diagnosed by OCT. This time, 2 stents were implanted in the affected artery. The hypothesis that the coronary adventitial volume of vasa vasorum is higher in patients with spontaneous coronary artery dissection has been demonstrated in a recent small study and it was observed in this patient. Conservative management is preferred in most cases, proceeding to revascularization for patients with ongoing chest pain, hemodynamic instability and ST elevation, mostly if it affects major arteries.
authors.affiliation: Cardiology Department, Universitary Hospital of Badajoz, Badajoz, Spain. Electronic address: brunolimpo@yahoo.com.
authors.forename: Bruno
authors.initials: B
authors.lastname: Limpo
authors.affiliation: Cardiology Department, Universitary Hospital of Badajoz, Badajoz, Spain.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Nogales-Asensio
authors.affiliation: Cardiology Department, Universitary Hospital of Badajoz, Badajoz, Spain.
authors.forename: María Reyes
authors.initials: MR
authors.lastname: González-Fernández
authors.affiliation: Cardiology Department, Universitary Hospital of Badajoz, Badajoz, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Merchán-Herrera
authors.affiliation: Cardiology Department, Universitary Hospital of Badajoz, Badajoz, Spain.
authors.forename: Jose Ramón
authors.initials: JR
authors.lastname: López-Mínguez
mesh_terms: D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012008:Recurrence; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D041623:Tomography, Optical Coherence; D014652:Vascular Diseases / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery
keywords: Coronary; Dissection; Spontaneous