Spontaneous Coronary Artery Dissection in a Young Obese Woman

Aim. Using a clinical example, to demonstrate the possibility of developing spontaneous coronary artery dissection with the formation of myocardial infarction in a young obese woman. Key points. Obesity is one of the leading factors in the development of metabolic syndrome and related cardiovascular diseases. There is evidence of a relationship between metabolic disorders and the development of myocardial infarction in young women. Spontaneous coronary artery dissection as a cause of myocardial infarction in young women with metabolic disorders is discussed in the scientific literature. However, there is insufficient information on this issue. The presented clinical case discusses a possible relationship between extreme obesity and the development of spontaneous coronary artery dissection, which caused myocardial infarction in a 35-year-old obese woman who underwent bariatric surgery for this reason. The clinical picture was typical of the anginal variant of the initial period of myocardial infarction. Narcotic analgesics were required to relieve the pain syndrome. During emergency coronary angiography, spontaneous dissection of the left coronary artery trunk — intermediate third of the anterior interventricular branch type B-C according to Ellis with signs of parietal thrombosis, occlusion of the apical segment was detected. Recanalization of the anterior interventricular branch with subsequent direct stenting of the left coronary artery trunk — anterior interventricular branch was performed. The treatment measures taken, according to the protocol for managing patients with acute coronary syndrome, brought a positive result, on the 9th day of the disease, she was discharged from the hospital for outpatient follow-up care. However, failure to comply with medical recommendations (did not take antiplatelet drugs) led to a relapse of myocardial infarction caused by stent thrombosis. Repeated percutaneous coronary intervention and the treatment and resuscitation measures carried out were unsuccessful. The patient's death was confirmed. The pathological examination fully confirmed the diagnosis of spontaneous coronary artery dissection and recurrent myocardial infarction. Conclusion. Despite the low incidence of coronary pathology in young women, it is necessary to be alert to this pathology and the possibility of developing spontaneous coronary artery dissection with the formation of type II myocardial infarction, especially in the presence of metabolic disorders.