SHM Converge Scientific Abstract ePoster Gallery-Recurrent Spontaneous Coronary Artery Dissection

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This case describes a 63-year-old woman with a prior spontaneous coronary artery dissection (SCAD) of the left anterior descending artery who returned two years later with chest pain and dyspnea. Her EKG showed ST elevations in leads II, III, and aVF, consistent with an inferior STEMI. Emergency coronary angiography revealed a severe 90% stenosis in a long segment of the right posterior descending artery with distal vessel pruning, findings consistent with recurrent SCAD. Initial TIMI 1 flow improved to TIMI 2 after intracoronary nitroglycerin. Echocardiography showed preserved left ventricular function with an ejection fraction of 60–65%.<br /><br />The report emphasizes that SCAD is an important cause of acute coronary syndrome and can recur, often in a different coronary territory. Recurrence rates are reported to be 29% within 2–3 years and 11% within 10 years. Current management focuses on goal-directed medical therapy, especially beta-blockers and tight blood pressure control. In this patient, these measures were already in place, and no coronary tortuosity was noted, suggesting that recurrence can still occur despite appropriate therapy.<br /><br />The case also highlights the need for better risk stratification for SCAD recurrence, including possible associations with smoking. The patient was counseled on tobacco cessation because continued smoking may increase the risk of future events. Overall, the report underscores that recurrent SCAD can present as myocardial infarction and that medical therapy may not fully prevent repeat coronary events.

Asset Subtitle

Nishita Vattem

Meta Tag

Author List Dhruv Joshi, Dureshahwar Ali, Nishita Vattem, Vijay Kata

Category Clinical Vignettes

Concept Spontaneous Coronary Artery Dissection

Concept Acute Coronary Syndrome

Concept STEMI

Concept Coronary Angiography

Concept Chest Pain

Distinguished Non-Finalist

Presenter Organization Riverside Medical Center

Presenting Author Nishita Vattem

Track Adult

Keywords

spontaneous coronary artery dissection

SCAD recurrence

inferior STEMI

right posterior descending artery

coronary angiography

chest pain

dyspnea

beta-blocker therapy

tobacco cessation

myocardial infarction

Spontaneous Coronary Artery Dissection

Acute Coronary Syndrome

STEMI

Coronary Angiography

Chest Pain