Spontaneous coronary artery dissection in young men. Case report.
Spontaneous coronary artery dissection (SCAD) is a very rare etiology of acute coronary syndrome in young patients causing 1-4% of these, it has a predilection for women representing > 80% of cases. There are multiple factors associated to SCAD such as fibromusc...
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| Formato: | Artículo revista |
| Lenguaje: | Español |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2019
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| Materias: | |
| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/25888 |
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I10-R327-article-25888 |
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ojs |
| institution |
Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
| topic |
coronary dissection lupus anticoagulation disección lupus anticoagulación |
| spellingShingle |
coronary dissection lupus anticoagulation disección lupus anticoagulación Tissera, YS Alonso, CG Quaglia, MI Savio, V Albiero, JA Gobbi, C Alba, P Spontaneous coronary artery dissection in young men. Case report. |
| topic_facet |
coronary dissection lupus anticoagulation disección lupus anticoagulación |
| author |
Tissera, YS Alonso, CG Quaglia, MI Savio, V Albiero, JA Gobbi, C Alba, P |
| author_facet |
Tissera, YS Alonso, CG Quaglia, MI Savio, V Albiero, JA Gobbi, C Alba, P |
| author_sort |
Tissera, YS |
| title |
Spontaneous coronary artery dissection in young men. Case report. |
| title_short |
Spontaneous coronary artery dissection in young men. Case report. |
| title_full |
Spontaneous coronary artery dissection in young men. Case report. |
| title_fullStr |
Spontaneous coronary artery dissection in young men. Case report. |
| title_full_unstemmed |
Spontaneous coronary artery dissection in young men. Case report. |
| title_sort |
spontaneous coronary artery dissection in young men. case report. |
| description |
Spontaneous coronary artery dissection (SCAD) is a very rare etiology of acute coronary syndrome in young patients causing 1-4% of these, it has a predilection for women representing > 80% of cases. There are multiple factors associated to SCAD such as fibromuscular dysplasia, pregnancy, mixed connective tissue disorders or inflammatory disease.
The objective was to review the importance of causes of non-atherosclerotic coronary syndrome in young men.
Clinical case: A 29-year-old man, without toxic habits, with a history of Systemic Lupus Erythematosus (SLE) with cutaneous, articular, renal involvement, ANA (+), Anti DNA (+) and hypocomplementemia, 4 years of evolution. He is hospitalized due to knee cellulitis, and received intravenous antibiotic treatment. Repolarization disorders and anteroseptal face fibrosis of the left ventricle (VI) are found in the lectrocardiogram. At anamnesis, he reported that 2 months ago, he had an oppressive precordial pain episode irradiated to the left arm, intensity 8/10 triggered by the effort and 4 hours long approximately. He was discharged after a time of observation. Asymptomatic since then. New autoimmune serology: Lupus anticoagulant +. Cinecoronariography is performed showing spontaneous dissection of the circumflex and anterior descending artery. Medical treatment with aspirin and anticoagulation is established.
SCAD is a rare cause of acute coronary syndrome, more frequent in females, the average age is 50 years, different to our case. The presence of traditional risk factors is rare, so their physiopathogenesis is not clear, when they are associated with pathologies such as systemic lupus erythematosus, there may be an eosinophilic infiltration of the vessel followed by the release of lytic enzymes, causing dissection. The diagnosis is based on suspicion and the performance of the coronary angiography to achieve timely treatment, there isn’t consensus about it but anticoagulation is accepted.
There are few reports of SCAD associated with lupus and antiphospholipid syndrome, it is important to suspect acute coronary syndrome even in young patients with autoimmune pathologies, since these cause significant morbidity and mortality in this population. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2019 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/25888 |
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I10-R327-article-258882024-08-27T18:26:34Z Spontaneous coronary artery dissection in young men. Case report. Disección espontánea de arterias coronarias en varón joven. A proposito de un caso. Tissera, YS Alonso, CG Quaglia, MI Savio, V Albiero, JA Gobbi, C Alba, P coronary dissection lupus anticoagulation disección lupus anticoagulación Spontaneous coronary artery dissection (SCAD) is a very rare etiology of acute coronary syndrome in young patients causing 1-4% of these, it has a predilection for women representing > 80% of cases. There are multiple factors associated to SCAD such as fibromuscular dysplasia, pregnancy, mixed connective tissue disorders or inflammatory disease. The objective was to review the importance of causes of non-atherosclerotic coronary syndrome in young men. Clinical case: A 29-year-old man, without toxic habits, with a history of Systemic Lupus Erythematosus (SLE) with cutaneous, articular, renal involvement, ANA (+), Anti DNA (+) and hypocomplementemia, 4 years of evolution. He is hospitalized due to knee cellulitis, and received intravenous antibiotic treatment. Repolarization disorders and anteroseptal face fibrosis of the left ventricle (VI) are found in the lectrocardiogram. At anamnesis, he reported that 2 months ago, he had an oppressive precordial pain episode irradiated to the left arm, intensity 8/10 triggered by the effort and 4 hours long approximately. He was discharged after a time of observation. Asymptomatic since then. New autoimmune serology: Lupus anticoagulant +. Cinecoronariography is performed showing spontaneous dissection of the circumflex and anterior descending artery. Medical treatment with aspirin and anticoagulation is established. SCAD is a rare cause of acute coronary syndrome, more frequent in females, the average age is 50 years, different to our case. The presence of traditional risk factors is rare, so their physiopathogenesis is not clear, when they are associated with pathologies such as systemic lupus erythematosus, there may be an eosinophilic infiltration of the vessel followed by the release of lytic enzymes, causing dissection. The diagnosis is based on suspicion and the performance of the coronary angiography to achieve timely treatment, there isn’t consensus about it but anticoagulation is accepted. There are few reports of SCAD associated with lupus and antiphospholipid syndrome, it is important to suspect acute coronary syndrome even in young patients with autoimmune pathologies, since these cause significant morbidity and mortality in this population. La disección espontánea de las arterias coronarias (DEAC) es una causa muy rara de síndromes coronarios agudos en pacientes jóvenes produciendo el 1 – 4% de estos, tiene predilección por las mujeres representando >80%de los casos. Existen múltiples factores asociados como la displasia fibromuscular, embarazo, trastornos mixtos del tejido conectivo o inflamatorios. El objetivo fue revisar la importancia de causas de sindrome coronario no aterosclerótico en varon joven. Caso clínico: Hombre de 29 años, sin hábitos tóxicos con antecedentes de Lupus Eritematoso Sistémico (LES) con compromiso cutáneo, articular, renal con ANA, Anti DNA (+) e hipocomplementemia, de 4 años de evolución. Ingresa con diagnóstico de celulitis de rodilla para tratamiento antibiótico endovenoso; dentro de los estudios realizados se hallan en el electrocardiograma trastornos en la repolarización y fibrosis en cara anteroseptal de ventrículo izquierdo (VI), en la anamnesis refiere que hace 2 meses tuvo un episodio de dolor precordial opresivo irradiado a brazo izquierdo, intensidad 8/10 desencadenado por el esfuerzo que duró aproximadamente 4 hs por lo que consultó en otro centro y tras observación fue dado de alta. Asintomático desde entonces. Nueva serología autoinmune: Anticoagulante lúpico positivo. Se realiza cinecoronariografía que muestra disección espontánea de arteria circunfleja y descendente anterior. Se instaura tratamiento médico con aspirina y anticoagulación. La DEAC es una causa rara de síndrome coronario agudo más frecuente en sexo femenino, la edad promedio es de 50 años, a diferencia del paciente presentado. Es rara la presencia de factores de riesgo tradicionales por lo que su fisiopatogenia no es clara, cuando están asociados a patologías como el lupus eritematoso sistémico puede existir una infiltración eosinofílica del vaso seguida de la liberación de enzimas líticas, causando la disección. El diagnóstico se basa en la sospecha y la realización de la cinecoronariografía para lograr tratamiento oportuno sobre el que no existe consenso pero es aceptada la anticoagulación. Existen escasos reportes de DEAC asociado a lupus y síndrome antifosfolipídico, es importante la sospecha de síndrome coronario agudo aún en pacientes jóvenes con patologías autoinmunes, ya que estas producen importante morbimortalidad en esta población. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2019-10-22 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/25888 Revista de la Facultad de Ciencias Médicas de Córdoba.; 2019: Suplemento JIC XX Revista de la Facultad de Ciencias Médicas de Córdoba; 2019: Suplemento JIC XX Revista da Faculdade de Ciências Médicas de Córdoba; 2019: Suplemento JIC XX 1853-0605 0014-6722 10.31053/1853.0605.v76.nSuplemento spa https://revistas.unc.edu.ar/index.php/med/article/view/25888/27709 Derechos de autor 2019 Universidad Nacional de Córdoba https://creativecommons.org/licenses/by-nc/4.0 |