Unexpected case of critical left main coronary artery dissection in a young woman
A 36-year-old woman presented with a 3-month history of recurrent substernal chest pain, which acutely worsened 2 days prior to presentation. Her initial troponin I was mildly elevated and ECG showed subtle changes initially concerning for ischaemia; however, these were present on her prior ECG and...
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| Veröffentlicht in: | BMJ case reports 2020-09, Vol.13 (9), p.e236379 |
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| creator | Butt, Ifrah Zahid Kazemi, Vahid Mohammadi, Oranus Danckers, Mauricio |
| description | A 36-year-old woman presented with a 3-month history of recurrent substernal chest pain, which acutely worsened 2 days prior to presentation. Her initial troponin I was mildly elevated and ECG showed subtle changes initially concerning for ischaemia; however, these were present on her prior ECG and were not considered an acute change. Because of her age and lack of significant risk factors, she was considered low risk for cardiac disease and initially treated conservatively for a non-ST elevation myocardial infarction. Due to persistent symptoms and dynamic changes on ECG concerning for ischaemia, she was immediately taken for a cardiac catheterisation and was found to have critical left main coronary artery dissection with a focal stenotic lesion. She had an extensive workup to identify the underlying cause of her coronary artery dissection which was unrevealing. She underwent an uncomplicated coronary artery bypass graft surgery and was discharged home in stable condition. |
| doi_str_mv | 10.1136/bcr-2020-236379 |
| format | Article |
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Her initial troponin I was mildly elevated and ECG showed subtle changes initially concerning for ischaemia; however, these were present on her prior ECG and were not considered an acute change. Because of her age and lack of significant risk factors, she was considered low risk for cardiac disease and initially treated conservatively for a non-ST elevation myocardial infarction. Due to persistent symptoms and dynamic changes on ECG concerning for ischaemia, she was immediately taken for a cardiac catheterisation and was found to have critical left main coronary artery dissection with a focal stenotic lesion. She had an extensive workup to identify the underlying cause of her coronary artery dissection which was unrevealing. She underwent an uncomplicated coronary artery bypass graft surgery and was discharged home in stable condition.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2020-236379</identifier><identifier>PMID: 32943445</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd</publisher><subject>Acute coronary syndromes ; Adult ; Age ; Aneurysm, Dissecting - complications ; Aneurysm, Dissecting - diagnosis ; Aneurysm, Dissecting - surgery ; Anticoagulants ; Atherosclerosis ; Cardiac arrhythmia ; Cardiovascular disease ; cardiovascular medicine ; Case reports ; Chest Pain - etiology ; Connective tissue ; Conservative Treatment ; Coronary Aneurysm - complications ; Coronary Aneurysm - diagnosis ; Coronary Aneurysm - surgery ; Coronary Angiography ; Coronary Artery Bypass ; Coronary vessels ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - surgery ; Diabetes ; Diagnostic Errors ; Dissection ; Electrocardiography ; Female ; Heart attacks ; Humans ; Hypothyroidism ; interventional cardiology ; ischaemic heart disease ; Ischemia ; Non-ST Elevated Myocardial Infarction - diagnosis ; Non-ST Elevated Myocardial Infarction - therapy ; Pain ; Patients ; Population ; Pregnancy ; Reminder of Important Clinical Lesson ; Risk factors ; Sinuses ; Treatment Outcome ; Urine ; Veins & arteries ; Womens health</subject><ispartof>BMJ case reports, 2020-09, Vol.13 (9), p.e236379</ispartof><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2020 BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-b411t-9c7e83420e62e0afacd989bdc832829bc04625bb517869939fe055826f2d2b843</cites><orcidid>0000-0003-1219-8416</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500194/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500194/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32943445$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Butt, Ifrah Zahid</creatorcontrib><creatorcontrib>Kazemi, Vahid</creatorcontrib><creatorcontrib>Mohammadi, Oranus</creatorcontrib><creatorcontrib>Danckers, Mauricio</creatorcontrib><title>Unexpected case of critical left main coronary artery dissection in a young woman</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><addtitle>BMJ Case Rep</addtitle><description>A 36-year-old woman presented with a 3-month history of recurrent substernal chest pain, which acutely worsened 2 days prior to presentation. Her initial troponin I was mildly elevated and ECG showed subtle changes initially concerning for ischaemia; however, these were present on her prior ECG and were not considered an acute change. Because of her age and lack of significant risk factors, she was considered low risk for cardiac disease and initially treated conservatively for a non-ST elevation myocardial infarction. Due to persistent symptoms and dynamic changes on ECG concerning for ischaemia, she was immediately taken for a cardiac catheterisation and was found to have critical left main coronary artery dissection with a focal stenotic lesion. She had an extensive workup to identify the underlying cause of her coronary artery dissection which was unrevealing. She underwent an uncomplicated coronary artery bypass graft surgery and was discharged home in stable condition.</description><subject>Acute coronary syndromes</subject><subject>Adult</subject><subject>Age</subject><subject>Aneurysm, Dissecting - complications</subject><subject>Aneurysm, Dissecting - diagnosis</subject><subject>Aneurysm, Dissecting - surgery</subject><subject>Anticoagulants</subject><subject>Atherosclerosis</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>cardiovascular medicine</subject><subject>Case reports</subject><subject>Chest Pain - etiology</subject><subject>Connective tissue</subject><subject>Conservative Treatment</subject><subject>Coronary Aneurysm - complications</subject><subject>Coronary Aneurysm - diagnosis</subject><subject>Coronary Aneurysm - surgery</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Bypass</subject><subject>Coronary vessels</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - surgery</subject><subject>Diabetes</subject><subject>Diagnostic Errors</subject><subject>Dissection</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Hypothyroidism</subject><subject>interventional cardiology</subject><subject>ischaemic heart disease</subject><subject>Ischemia</subject><subject>Non-ST Elevated Myocardial Infarction - diagnosis</subject><subject>Non-ST Elevated Myocardial Infarction - therapy</subject><subject>Pain</subject><subject>Patients</subject><subject>Population</subject><subject>Pregnancy</subject><subject>Reminder of Important Clinical Lesson</subject><subject>Risk factors</subject><subject>Sinuses</subject><subject>Treatment Outcome</subject><subject>Urine</subject><subject>Veins & arteries</subject><subject>Womens health</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kd1rFTEQxYMotrR99k0CvgiyNp-b5EWQ4hcUitBC30KSna257CbXZLfa_95cbq1VMC8TmN-cmcNB6AUlbynl_akPpWOEkY7xnivzBB1SJVWnDLl--uh_gE5q3ZD2OBVa8OfogDMjuBDyEH29SvBzC2GBAQdXAecRhxKXGNyEJxgXPLuYcMglJ1fusCsLtDLEWttQzAm3rsN3eU03-EeeXTpGz0Y3VTi5r0fo6uOHy7PP3fnFpy9n7887LyhdOhMUaC4YgZ4BcaMLg9HGD0FzppnxgYieSe8lVbo3hpsRiJSa9SMbmG82jtC7ve529TMMAdJS3GS3Jc7tUJtdtH93Uvxmb_KtVZIQanYCr-8FSv6-Ql3sHGuAaXIJ8lotE0JwTbmWDX31D7rJa0nNnmWSMkWU6nfU6Z4KJddaYHw4hhK7S8y2xOwuMbtPrE28fOzhgf-dTwPe7AE_b_7s_J_cLzsunyA</recordid><startdate>20200917</startdate><enddate>20200917</enddate><creator>Butt, Ifrah Zahid</creator><creator>Kazemi, Vahid</creator><creator>Mohammadi, Oranus</creator><creator>Danckers, Mauricio</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1219-8416</orcidid></search><sort><creationdate>20200917</creationdate><title>Unexpected case of critical left main coronary artery dissection in a young woman</title><author>Butt, Ifrah Zahid ; 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Her initial troponin I was mildly elevated and ECG showed subtle changes initially concerning for ischaemia; however, these were present on her prior ECG and were not considered an acute change. Because of her age and lack of significant risk factors, she was considered low risk for cardiac disease and initially treated conservatively for a non-ST elevation myocardial infarction. Due to persistent symptoms and dynamic changes on ECG concerning for ischaemia, she was immediately taken for a cardiac catheterisation and was found to have critical left main coronary artery dissection with a focal stenotic lesion. She had an extensive workup to identify the underlying cause of her coronary artery dissection which was unrevealing. She underwent an uncomplicated coronary artery bypass graft surgery and was discharged home in stable condition.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd</pub><pmid>32943445</pmid><doi>10.1136/bcr-2020-236379</doi><orcidid>https://orcid.org/0000-0003-1219-8416</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Acute coronary syndromes Adult Age Aneurysm, Dissecting - complications Aneurysm, Dissecting - diagnosis Aneurysm, Dissecting - surgery Anticoagulants Atherosclerosis Cardiac arrhythmia Cardiovascular disease cardiovascular medicine Case reports Chest Pain - etiology Connective tissue Conservative Treatment Coronary Aneurysm - complications Coronary Aneurysm - diagnosis Coronary Aneurysm - surgery Coronary Angiography Coronary Artery Bypass Coronary vessels Coronary Vessels - diagnostic imaging Coronary Vessels - surgery Diabetes Diagnostic Errors Dissection Electrocardiography Female Heart attacks Humans Hypothyroidism interventional cardiology ischaemic heart disease Ischemia Non-ST Elevated Myocardial Infarction - diagnosis Non-ST Elevated Myocardial Infarction - therapy Pain Patients Population Pregnancy Reminder of Important Clinical Lesson Risk factors Sinuses Treatment Outcome Urine Veins & arteries Womens health |
| title | Unexpected case of critical left main coronary artery dissection in a young woman |
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