A Case of Spontaneous Coronary Artery Dissection in a Patient with Severe Anorexia Nervosa

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe anorexia nervosa and spontaneous coronary artery dissection (SCAD) (n=1). Intervention: Severe anorexia nervosa. Primary outcome: Spontaneous coronary artery dissection (SCAD) of the first septal perforator artery.

Q: What does this research mean for the field?

Severe anorexia nervosa can predispose patients to spontaneous coronary artery dissection, likely driven by severe nutritional, endocrine, and vascular endothelial derangements. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

J O'Neil; Soumyaa Mazumder; Danita Y. Sanborn; Samantha Wu

doi:10.1155/2021/5526022

June 23, 2021Case Reports in CardiologyOpen Access

A Case of Spontaneous Coronary Artery Dissection in a Patient with Severe Anorexia Nervosa

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Key result

Severe anorexia nervosa linked to isolated septal perforator spontaneous coronary artery dissection.

n=1

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Key Points

To describe a rare case of spontaneous coronary artery dissection in a patient with severe anorexia nervosa and review potential predisposing pathophysiological mechanisms.
Documented the clinical presentation, laboratory workup, echocardiography, and computed tomography coronary angiography of a 55-year-old female with severe anorexia nervosa (BMI 12).
Conducted a literature review of spontaneous coronary artery dissection associated with anorexia nervosa to explore hormonal, nutritional, and mechanical risk factors.
The patient presented unresponsive with severe hypoglycemia (14 mg/dL), hypothermia (90.2°F), physical findings of scurvy, vitamin C deficiency (0.3 mg/dL), and a peak high-sensitivity troponin of 364 ng/dL.
Computed tomography coronary angiography identified a linear hypodensity and abrupt vessel tapering in the proximal first septal perforator artery without atherosclerosis, confirming spontaneous coronary artery dissection.
Conservative management was initiated using aspirin, metoprolol, and cardiac rehabilitation.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 55-year-old woman (BMI 12, 35 kg) with severe anorexia nervosa presenting with unconsciousness, hypoglycemia, hypothermia, and spontaneous coronary artery dissection of the first septal perforator artery.

E

Exposure

Conservative medical therapy with initiation of aspirin, metoprolol, and cardiac rehabilitation (following initial stabilization with intravenous dextrose and rewarming).

O

Outcome

Diagnosis of spontaneous coronary artery dissection (SCAD) of the proximal first septal perforator artery (linear hypodensity and abrupt tapering 5 mm from origin on CT coronary angiogram) with septal myocardial infarction.hard clinical

This case report highlights spontaneous coronary artery dissection as a potentially underdiagnosed, life-threatening cardiac complication in patients with severe anorexia nervosa driven by nutritional, endocrine, and physical stressors.

Limitations

Single patient case report
Thyroid function tests were confounded by a supratherapeutic levothyroxine dose
Further studies are needed to understand whether patients with anorexia nervosa are at increased risk for SCAD
Thyroid function tests in this patient were confounded by a supratherapeutic levothyroxine dose
Further studies will be needed to understand whether patients with anorexia nervosa may be at increased risk for SCAD

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Implication

Alerts clinicians to consider SCAD in severe anorexia nervosa with chest pain; leaves open causal role of nutritional stressors pending larger studies.

Abstract

There are a variety of cardiac complications of anorexia nervosa including arrythmias, valvopathies, and myopathies. Spontaneous coronary artery dissection (SCAD) has not been widely reported among this patient population. This case report describes a middle-aged female with severe anorexia nervosa, who presented after being found unconscious, and was later diagnosed with SCAD. A literature review revealed one previous case of SCAD in a patient with anorexia nervosa and prompted a discussion of a series of possible predisposing factors for SCAD in this patient population. Patients with anorexia nervosa may be at increased risk for SCAD due to their complex nutritional and endocrine imbalances. This case highlights a possible underdiagnosed cardiac complication of anorexia nervosa.

Discussion

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Cite This Study

O'Neil et al. (2021) conducted a case report in Severe anorexia nervosa and spontaneous coronary artery dissection (SCAD) (n=1). Severe anorexia nervosa was evaluated on Spontaneous coronary artery dissection (SCAD) of the first septal perforator artery. Severe anorexia nervosa in a 55-year-old woman (BMI 12) was associated with spontaneous coronary artery dissection of the first septal perforator artery (peak hs-troponin 364 ng/dL, LVEF 52%).

synapsesocial.com/papers/6a78ce16a2e0f1c8cff99732 https://doi.org/10.1155/2021/5526022

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A Case of Spontaneous Coronary Artery Dissection in a Patient with Severe Anorexia Nervosa

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A Case of Spontaneous Coronary Artery Dissection in a Patient with Severe Anorexia Nervosa

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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