Spontaneous coronary dissection presenting with reperfusion arrhythmia: A case report

Khawar Maqsood, Marwan Badri, James F. Burke, Wajeeha Saeed, Ghazi Mirrani, Nosheen Sarwar, Joseph Kusick, Frank C. McGeehin, Paul M. Coady, Muhammad R. Sardar

Department of Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, USA;.
Department of Medicine, Division of Cardiology, Lankenau Medical Center, Wynnewood, USA.
Department of Medicine, Division of Internal Medicine, Bronx-Lebanon Hospital Center, New York, USA.
Department of Medicine, Division of Internal Medicine, Lankenau Medical Center, Wynnewood, USA.

DOI: 10.4236/crcm.2013.23058                

Abstract

Spontaneous coronary dissection is more commonly reported in females and is an important differential diagnosis for acute coronary syndrome. Accelerated idioventricular rhythm has been reported before with reperfusion post myocardial ischemia. We report a case of accelerated idioventricular rhythm in a patient with spontaneous coronary artery dissection. A 45-year-old Caucasian female presented with left sided chest pain radiating to the neck and palpitations. Admission ECG showed accelerated idioventricular rhythm. Troponin I peaked at 0.5 ng/ml. Coronary angiography showed mid to distal left anterior descending artery dissection with adequate distal flow. Patient was initially medically managed with aspirin, metoprolol, intravenous heparin and eptifibatide infusions but continued to have symptoms of unstable angina. She underwent successful percutaneous coronary intervention with 2 drug eluting stents and was discharged back home symptom free on dual platelet therapy. Spontaneous coronary artery dissection is an important differential diagnosis for acute coronary syndrome especially in younger females. Accelerated idioventricular rhythm can be a presentation of coronary dissection and may indicate instability. Early percutaneous coronary intervention should be considered in such patients.

Keywords

Spontaneous Coronary Dissection; Accelerated Idioventricular Rhythm

Conflicts of Interest

The authors declare no conflicts of interest.

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