ABSTRACT

Primary spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and is ob- served especially during gestation or the postpartum period of young healthy female patients. SCAD is much more rarely seen in young male patients. A 32 year-old male was admitted to our clinic with a typical anginal complaint that had begun after a verbal discussion in a family environment. The patient was hospitalized with a diagnosis of acute myocardial infarction without ST elevation. During coronary angiography, a lesion seen as a dissection in the proximal region of the left anterior descending artery (LAD), 30% stenosis in the circumflex ar- tery and plaque in the right coronary artery were observed. In the LAD osteal region, a dissection flap and intimal rupture was observed at the 12:00–2:00 o'clock position using intravascular ultrasonography (IVUS). Our case was very young and had no atherosclerotic risk factors except for a history of smoking. It was suggested that in- tense emotional stress was the triggering factor for coronary dissection. The gold standard imaging method for spontaneous coronary dissection is coronary angiography. Recently, imaging methods like IVUS have made im- portant contributions to the diagnosis of dissections that cannot be detected by coronary angiography. Treatment must be individual since there is no standard protocol. Medical therapy, percutaneous coronary intervention and coronary artery bypass surgery are the main treatment options.

Keywords: Spontaneous coronary dissection Acute coronary syndrome Intravscular ultrasound