Chronic or Changeable Infarct Size after Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) could be the cause of acute myocardial infarction (AMI) and sudden cardiac death. Clinical presentations can vary considerably, but the most common is the elevation of cardiac biomarkers associated with chest discomfort. Different pathological etiology in comparison with Type 1 AMI is the underlying infarct size in this population. A 42-year-old previously healthy woman presented with SCAD. Detailed diagnostical processing and treatment which were performed could not prevent myocardial injury. The catheterization laboratory was the initial place for the establishment of a diagnosis and proper management. The management process can be very fast and sometimes additional imaging methods are necessary. Finding predictors of SCAD recurrence is challenging, as well as predictors of the resulting infarct scar size. Patients with recurrent clinical symptoms of chest pain, ST elevation, and complication represent a special group of interest. Therapeutic approaches for SCAD range from the watch and wait method to complete revascularization with the implantation of one or more stents or aortocoronary bypass grafting. The infarct size could be balanced through the correct therapeutical approach, and, proper multimodality imaging would be helpful in the assessment of infarct size.

Automated summary

Spontaneous coronary artery dissection (SCAD) is a possible cause of acute myocardial infarction (AMI) and sudden cardiac death. The clinical presentation of SCAD can vary, but the most common symptom is elevated cardiac biomarkers accompanied by chest discomfort. SCAD has a different pathological etiology compared to Type 1 AMI, affecting the size of the infarct. Management of SCAD typically begins in the catheterization laboratory, where a diagnosis is established and appropriate treatment is initiated. Additional imaging methods may be necessary for a fast and accurate management process.