2009 Southern Regional Meeting Abstracts

Case Report: ALG is a 40 year old female with history of dyslipidemia on statin therapy, family history of CAD, and no toxic habits. She presented to our ER due to oppressive type chest pain (10/10), diaphoresis and syncope. Her initial EKG showed ST-T segment depressions from lead V1 to V6 and intermittent RBBB. In view of her symptoms and EKG changes, she was taken to the Catheterization Laboratory for evaluation. Left Heart Catheterization revealed a left main coronary dissection extending all the was into the left anterior descending artery. Patient developed non sustained ventricular tachycardia requiring full ACLS, orotracheal intubation and electrical cardioversion. Emergency Percutaneous Coronary Intervention directed at the left main dissection was undertaken. Successful stent placement from the left main coronary into the LAD prevented any further dissection. Intra Aortic Balloon Pump was placed and the patient was admitted to the CCU. Ejection Fraction just after the procedure was 5-10% by 2D Echo. IABP could be discontinued in the next couple of days and EF improved to 40-50% just before hospital discharge. Rheumatoid factor and CRP levels were mildly elevated. However, B-HCG, ANA, DNA Ab DS, RPR, Complement 50, Histone Ab, ESR, and Homocysteine levels were all negative. This is a puzzling case of a spontaneous left main coronary dissection in a young non-pregnant woman with no apparent major risk factors or rheumatologic condition. She is still undergoing further work up to explain a reason for this event and to see if she or any family member is at risk for a future similar event.