Key result
Conservative management with vasodilators achieves spontaneous healing of coronary intramural hematoma at 15 days.
Why the study?
Coronary intramural hematoma presenting as acute coronary syndrome and its optimal management remain unclear.
Case Report (n=1)
No
Conservative management can be an effective strategy for coronary intramural hematoma presenting as acute coronary syndrome when coronary flow is maintained and symptoms resolve.
Hypothesis-generating for conservative management in select coronary intramural hematoma cases; larger prospective studies needed before practice change.
We herein report a case of intramural hematoma without ongoing myocardial ischemia that healed spontaneously with conservative treatment. A 37-year-old woman was admitted due to chest pain. Acute coronary syndrome was diagnosed by electrocardiography and echocardiography. Coronary angiography showed 90% stenosis in the distal portion of the left anterior descending coronary artery, where intravascular ultrasound showed a hematoma, but optical coherence tomography could not detect the entry point. Therefore, we identified the intramural hematoma as the etiology. Because the coronary flow was maintained and chest pain disappeared, we chose conservative treatment. Fifteen days after admission, coronary computed tomography showed an improvement in the intramural hematoma.
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Shimada et al. (2016) conducted a case report in Coronary Intramural Hematoma / Acute Coronary Syndrome (n=1). Conservative treatment was evaluated on Improvement in intramural hematoma and symptom resolution. Conservative treatment with vasodilators successfully managed a case of coronary intramural hematoma presenting as acute coronary syndrome, with spontaneous healing observed at 15 days.
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