Spontaneous coronary artery dissection in young men. Case report.

Abstract

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.