2009 Southern Regional Meeting Abstracts

Case Report: A 41-year-old woman with no history of systemic illness complained of severe, oppresive retrosternal pain of sudden onset with associated with shortness of breath and nausea. An electrocardiogram revealed ST-segment elevation of leads V1 through V5. The patient is initially treated with tenecteplase, but there is no improvement in symptoms nor electrocardiographic changes. Two hours later, the patient suffered ventricular fibrillation, requiring electrical defibrillation and mechanical ventilation. She is transferred to our institution for emergency percutaneous coronary intervention. Upon arrival, the patient is found in cardiogenic shock. Coronary angiography revealed aneurysmatic dilatation of the left main coronary artery with complete dissection of the left anterior descending artery and the ramus branch, causing distal occlusion of the affected vessels. The patient was submitted for emergency Coronary Artery Bypass Graft (CABG) surgery. No risk factors for coronary artery disease were found in this patient. This case illustrates spontaneous dissection of the coronary arteries, which is a rare cause of myocardial infarction. Fewer than 200 cases have been reported since first described in 1931. This condition occurs most frequently in pre-menopausal women and is thought to be caused by hormonal changes that cause weakness of the vasa vasorum and promote hemorrhage into the media.