Summary
Background. Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, and its clinical features are difficult to differentiate from myocardial infarction due to atherosclerosis. This pathology is more often diagnosed in young women without any traditional heart disease risk factors. The optimal treatment of spontaneous coronary artery dissection remains controversial, as no scientific studies comparing various drug therapies or different revascularization strategies have been conducted yet.
Case presentation. We present the clinical case of a 38-year-old woman complaining of acute chest pain. As increased troponin I and ECG signs of ischemia were present, it was decided to perform a coronary angiography. During the procedure a spontaneous coronary artery dissection was diagnosed and percutaneous coronary intervention with stenting was executed. One week later a control coronary angiography was performed. During the procedure the dissection spread proximally, and four more stents were placed. After being discharged, the patient was rehospitalized one week later due to repeat chest pain with elevated troponin I levels. Coronary CT angiography was performed and there was no new dissection in the non-stented vessels. While continuing further conservative treatment, acute chest pain did not occur again. However, mild chest pain and shortness of breath during physical exertion persisted.
Conclusions. The clinical picture of spontaneous coronary artery dissection resembles acute coronary syndrome of atherosclerotic origin. Thus, coronary angiography is the most important diagnostic tool. Spontaneous coronary artery dissection treatment remains controversial. Tactics should be chosen individually in each case, but conservative treatment is preferred. Recurrent chest pain after spontaneous coronary artery dissection is common. It is important to consider responsibly the need for invasive examination and revascularization.
