CRCM  Vol.2 No.3 , June 2013
Spontaneous coronary dissection presenting with reperfusion arrhythmia: A case report
Abstract: Spontaneous coronary dissection is more commonly reported in females and is an important differential diagnosis for acute coronary syndrome. Accelerated idioventricular rhythm has been reported before with reperfusion post myocardial ischemia. We report a case of accelerated idioventricular rhythm in a patient with spontaneous coronary artery dissection. A 45-year-old Caucasian female presented with left sided chest pain radiating to the neck and palpitations. Admission ECG showed accelerated idioventricular rhythm. Troponin I peaked at 0.5 ng/ml. Coronary angiography showed mid to distal left anterior descending artery dissection with adequate distal flow. Patient was initially medically managed with aspirin, metoprolol, intravenous heparin and eptifibatide infusions but continued to have symptoms of unstable angina. She underwent successful percutaneous coronary intervention with 2 drug eluting stents and was discharged back home symptom free on dual platelet therapy. Spontaneous coronary artery dissection is an important differential diagnosis for acute coronary syndrome especially in younger females. Accelerated idioventricular rhythm can be a presentation of coronary dissection and may indicate instability. Early percutaneous coronary intervention should be considered in such patients.
Cite this paper: Maqsood, K. , Badri, M. , Burke, J. , Saeed, W. , Mirrani, G. , Sarwar, N. , Kusick, J. , McGeehin, F. , Coady, P. and Sardar, M. (2013) Spontaneous coronary dissection presenting with reperfusion arrhythmia: A case report. Case Reports in Clinical Medicine, 2, 215-218. doi: 10.4236/crcm.2013.23058.

[1]   Shamloo, B.K., Chintala, R.S., Nasur, A., Ghazvini, M., Shariat, P., Diggs, J.A. and Singh, S.N. (2010) Spontaneous coronary artery dissection: Aggressive vs. conservative therapy. Journal of Invasive Cardiology, 22, 222-228.

[2]   Comerford, T.J. and Propert, D.B. (1979) Accelerated idioventricular rhythm in patients without acute myocardial infarction. Angiology, 30, 768-775. doi:10.1177/000331977903001106

[3]   Grimm, W., Hoffmann, J. and Maisch, B. (1994) Accelerated idioventricular rhythm. Zeitschrift für Kardiologie, 83, 898-907.

[4]   Terkelsen, C.J., Sorensen, J.T., Kaltoft, A.K., Nielsen, S.S., Thuesen, L., Botker, H.E. and Lassen, J.F. (2009) Prevalence and significance of accelerated idioventricular rhythm in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. American Journal of Cardiology, 104, 1641-1646. doi:10.1016/j.amjcard.2009.07.037

[5]   Jorgensen, M.B., Aharonian, V., Mansukhani, P. and Mahrer. P.R. (1994) Spontaneous coronary dissection: A cluster of cases with this rare finding. American Heart Journal, 127, 1382-1387. doi:10.1016/0002-8703(94)90060-4

[6]   Hering, D., Piper, C., Hohmann, C., Schultheiss, H.P. and Horstkotte, D. (1998) Incidence, etiology and therapy of spontaneous coronary artery dissection. A prospective monocenter study of 3800 consecutive patients. Zeitschrift für Kardiologie, 87, 961-970. doi:10.1007/s003920050253

[7]   Bateman, A.C., Gallagher, P.J. and Vincenti, A.C. (1995) Sudden death from coronary artery dissection. Journal of Clinical Pathology, 48, 781-784. doi:10.1136/jcp.48.8.781

[8]   Ades, L.C., Waltham, R.D., Chiodo, A.A. and Bateman, J.F. (1995) Myocardial infarction resulting from coronary artery dissection in an adolescent with Ehlers-Danlos syndrome type IV due to a type III collagen mutation. British Heart Journal, 74, 112-116. doi:10.1136/hrt.74.2.112

[9]   Aldoboni, A.H., Hamza, E.A., Majdi, K., et al. (2002) Spontaneous dissection of coronary artery treated by primary stenting as the first presentation of systemic lupus erythematosus. Journal of Invasive Cardiology, 14, 694-696.

[10]   Chu, K.H., Menapace, F.J., Blankenship, J.C., et al. (1998) Polyarteritis nodosa presenting as myocardial infarction with coronary dissection. Catheterization and Cardiovascular Diagnosis, 44, 320-324. doi:10.1002/(SICI)1097-0304(199807)44:3<320::AID-CCD16>3.3.CO;2-B

[11]   Evangelou, D., Letsas, K.P., Korantzopoulos, P., Antonellis, I., Sioras, E. and Kardaras, F. (2006) Spontaneous coronary artery dissection associated with oral contraceptive use: A case report and review of the literature. International Journal of Cardiology, 112, 380-382. doi:10.1016/j.ijcard.2005.07.069

[12]   Steinhauer, J.R. and Caulfield, J.B. (2001) Spontaneous coronary artery dissection associated with cocaine use: a case report and brief review. Cardiovascular Pathology, 10, 141-145. doi:10.1016/S1054-8807(01)00074-6

[13]   Adlam, D., Cuculi, F., Lim, C. and Banning, A. (2010) Management of spontaneous coronary artery dissection in the primary percutaneous coronary intervention era. Journal of Invasive Cardiology, 22, 549-553.

[14]   Kamran, M., Guptan, A. and Bogal, M. (2008) Spontaneous coronary artery dissection: case series and review. Journal of Invasive Cardiology, 20, 553-559.

[15]   Zampieri, P., Aggio, S., Roncon, L., Rinuncini, M., Canova, C., Zanazzi, G., Fiorencis, R. and Zonzin, P. (1996) Follow up after spontaneous coronary artery dissection: A report of five cases. Heart, 75, 208-209. doi:10.1136/hrt.75.2.206