Atherosclerotic spontaneous coronary artery dissection (A-SCAD) in a patient with COVID-19: case report and possible mechanisms
| Autor: | Giuseppe Seresini, Remo Albiero |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Acute coronary syndrome Coronavirus disease 2019 (COVID-19) SCAD medicine.medical_treatment 030204 cardiovascular system & hematology medicine.disease_cause 03 medical and health sciences 0302 clinical medicine Internal medicine Adventitia Case report medicine Coronary artery dissection business.industry COVID-19 PCI Thrombolysis A-SCAD ACS medicine.disease Vulnerable plaque Pneumonia medicine.anatomical_structure Conventional PCI Cardiology Cardiology and Cardiovascular Medicine Scad business 030217 neurology & neurosurgery |
| Zdroj: | European Heart Journal: Case Reports European Heart Journal-Case Reports |
| ISSN: | 2514-2119 |
| Popis: | BackgroundSpontaneous coronary artery dissection (SCAD) may be atherosclerotic (A-SCAD) or non-atherosclerotic (NA-SCAD) in origin. Contemporary usage of the term ‘SCAD’ is typically synonymous with NA-SCAD. COVID-19 could induce a vascular inflammation localized in the coronary adventitia and periadventitial fat and contribute to the development of an A-SCAD of a vulnerable plaque in a susceptible patient.Case summaryIn this report we describe a case of a COVID-19 patient with past cardiac history of CAD who was admitted for acute coronary syndrome (ACS). Coronary angiography demonstrated the culprit lesion in the proximal LAD that presented with a very complex and unusual morphology, indicative of an A-SCAD. The diagnosis of A-SCAD was supported by the presence of a mild stenosis in the same coronary segment in the last angiogram performed 3 years previously. He was successfully treated by PCI, had a favourable course of the COVID-19 with no symptoms of pneumonia, and was discharged from the hospital after two negative tests for SARS-CoV-2.DiscussionA higher index of suspicion of A-SCAD is needed in patients with suspected or confirmed COVID-19 presenting with ACS. The proposed approach with ‘thrombolysis first’ for treating STEMI patients with suspected or confirmed COVID-19 infection could be unsafe in the case of underlying A-SCAD. |
| Databáze: | OpenAIRE |
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