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33 YEAR OLD FEMALE WITH SUDDEN CARDIAC ARREST
2484 JACC March 21, 2017 Volume 69, Issue 11
FIT Clinical Decision Making 33 YEAR OLD FEMALE WITH SUDDEN CARDIAC ARREST Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision‐Making: Interventional Cardiology, Acute and Stable Ischemic Heart Disease, and Vascular Medicine Abstract Category: Acute and Stable Ischemic Heart Disease Presentation Number: 1300-432 Authors: Hiten R. Patel, Priyank Shah, Kunal Patel, Emile Doss, Fayez Shamoon, New York Medical College, Saint Joseph’s Regional Medical Center, Paterson, NJ, USA
Background: Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction; commonly seen in young women and often postpartum. It classically presents as an acute coronary syndrome and rarely can present as sudden cardiac arrest.
Case: A 33 year old female was found gasping for air and then unresponsive by her husband, early morning at 5am. She had no past medical history and was two weeks postpartum with normal vaginal delivery. There was no recent history of chest pain, shortness of breath or palpitations. Police were the first responders; initial rhythm was ventricular fibrillation and patient was successfully resuscitated with return of spontaneous circulation in 12 mins. She was intubated for airway protection in emergency department and initial ECG showed 3mm ST-elevation in leads V2-V5 and 1mm ST-elevation in leads V6, II, III and aVF; hence, she immediately underwent left heart catheterization.
Decision‐Making: Coronary angiography revealed mid LAD artery dissection with TIMI-1 flow and since the patient was hypotensive, this lesion was intervened with a drug eluting stent. After stent deployment, we noticed a retrograde dissection and an intramural hematoma extending up to the Left Main (LM) artery from the proximal edge of the initial stent. This was successfully treated with 3 drug eluting stents, initially covering the most proximal end of the retrograde dissection in the LM artery, with a final TIMI-3 flow. Later, hypothermia protocol was initiated and Intra-aortic balloon pump was inserted. Left ventriculogram showed mid anterior, apical anterior and apical inferior wall hypokinesis with left ventricular ejection fraction (LVEF) of 25%. After 2 days, 2-D echocardiogram showed improved LVEF of 50%. Patient did well and made a good functional and neurological recovery. Conclusions: Although conservative management is the preferred strategy in SCAD, this case illustrates that percutaneous coronary intervention (PCI) is necessary especially if the patient is hemodynamically unstable. And one must be vigilant while doing PCI in SCAD patients as it can be technically challenging (in part due to fragility of vessel wall) and is associated with higher complications.
FIT Clinical Decision Making 33 YEAR OLD FEMALE WITH SUDDEN CARDIAC ARREST Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision‐Making: Interventional Cardiology, Acute and Stable Ischemic Heart Disease, and Vascular Medicine Abstract Category: Acute and Stable Ischemic Heart Disease Presentation Number: 1300-432 Authors: Hiten R. Patel, Priyank Shah, Kunal Patel, Emile Doss, Fayez Shamoon, New York Medical College, Saint Joseph’s Regional Medical Center, Paterson, NJ, USA
Background: Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction; commonly seen in young women and often postpartum. It classically presents as an acute coronary syndrome and rarely can present as sudden cardiac arrest.
Case: A 33 year old female was found gasping for air and then unresponsive by her husband, early morning at 5am. She had no past medical history and was two weeks postpartum with normal vaginal delivery. There was no recent history of chest pain, shortness of breath or palpitations. Police were the first responders; initial rhythm was ventricular fibrillation and patient was successfully resuscitated with return of spontaneous circulation in 12 mins. She was intubated for airway protection in emergency department and initial ECG showed 3mm ST-elevation in leads V2-V5 and 1mm ST-elevation in leads V6, II, III and aVF; hence, she immediately underwent left heart catheterization.
Decision‐Making: Coronary angiography revealed mid LAD artery dissection with TIMI-1 flow and since the patient was hypotensive, this lesion was intervened with a drug eluting stent. After stent deployment, we noticed a retrograde dissection and an intramural hematoma extending up to the Left Main (LM) artery from the proximal edge of the initial stent. This was successfully treated with 3 drug eluting stents, initially covering the most proximal end of the retrograde dissection in the LM artery, with a final TIMI-3 flow. Later, hypothermia protocol was initiated and Intra-aortic balloon pump was inserted. Left ventriculogram showed mid anterior, apical anterior and apical inferior wall hypokinesis with left ventricular ejection fraction (LVEF) of 25%. After 2 days, 2-D echocardiogram showed improved LVEF of 50%. Patient did well and made a good functional and neurological recovery. Conclusions: Although conservative management is the preferred strategy in SCAD, this case illustrates that percutaneous coronary intervention (PCI) is necessary especially if the patient is hemodynamically unstable. And one must be vigilant while doing PCI in SCAD patients as it can be technically challenging (in part due to fragility of vessel wall) and is associated with higher complications.