부산대학교 도서관

Spontaneous coronary artery dissection is one of the possible causes of MINOCA defined by a separation of the intima or adventitia from the arterial wall and frequently related to a nontraumatic, noniatrogenic etiology. Coronary artery dissection often involves a single vessel most often represented by the anterior interventricular artery. Case report. An 82–year–old patient with a silent cardiology history presented to the emergency department after accidental ammonia inhalation reporting cough, epiphora, and chest pain. On admission ECG we show a normofrequent sinus rhythm with an EAS and a high lateral Q wave with a negative T wave. In view of the TnT values of 425 mg/dL, an indication for admission with a diagnosis of NSTEMI was posited. On echoscopy, a hypo–akinesis of the mid–distal portion of the anterolateral wall, posterior wall, and interventricular septum (SIV) with inspective left ventricular ejection fraction (FEVS) 35% was evident. In the face of persistence of modest angor, as well as further elevation of troponin values (1400 ng/L) and a significant change in electrocardiogram with development of right bundle branch block, the patient underwent urgent coronarography. Coronary angiography documented by IVUS analysis a spontaneous coronary artery dissection of the anterior descending artery (VAT) with the presence of a non–occlusive wall hematoma at the middle tract. In view of the patient‘s achieved asymptomaticity, hemodynamic stability, and ubiquitous TIMI 3 flow, a conservative approach was opted for, setting medical therapy with ASA + Clopidogrel "off–label" by virtue of the woman‘s low bleeding risk and high ischemic risk. Follow–up echocardiogram performed three days after the patient‘s arrival on the ward showed a fair recovery of biventricular systolic function with an FEVS of 50% with alterations in regional hypokinetic Chinese. Diagnosis was completed by cardiac MRI, which confirmed the ultrasound findings inherent in the kinesis and showed areas of edema at the anterior wall, anterior septum, and anterolateral wall in the absence of late ischemic myocardial enhancement. These findings were found to be suggestive of an associated TakoTsubo syndrome picture.