January 1, 1999
View Full PaperSpontaneous Coronary Artery Dissection: Case Report and Literature Review
Key Result
Early coronary angiography should be considered over thrombolytic therapy for diagnosing and managing primary spontaneous coronary artery dissection in young post partum women.
Study Design
Type
Case Report (n=142)
Structured PICO
P
Population
A 33-year-old woman 2 months post partum presenting with primary spontaneous coronary artery dissection, along with a literature review of 141 cases.
I
Intervention
Thrombolytic therapy followed by medical management (intravenous heparin, aspirin, nitrates, beta-blockers, digoxin, ACE inhibitor and anticoagulants)
O
Outcome
Clinical stabilization and symptom resolution
Spontaneous coronary artery dissection should be considered in young women presenting with acute ischemic syndrome, particularly post partum, and early angiography is recommended over empiric thrombolysis.
Abstract
Primary coronary artery dissection occurring 2 months post partum in a 33-year-old woman is described. Owing to suspected acute myocardial infarction, the patient was treated with thrombolytic therapy but her condition deteriorated. Coronary angiography showed dissection of the left anterior descending artery (LAD). Her condition stabilized during treatment with intravenous heparin, aspirin, nitrates, beta-blockers, digoxin, ACE inhibitor and anticoagulants. At discharge she had no symptoms of heart failure. One hundred and forty one cases from the literature are reviewed with special reference to patient characteristics, patient treatment, and prognosis. Primary spontaneous coronary artery dissection is a rare condition but one that must be considered when young people, especially post partum women, present an acute ischaemic syndrome. Thrombolytic therapy may be a two-edged sword and therefore early angiography should be considered in making the diagnosis and choosing the therapy.