ticagrelor and Coronary-Vessel-Anomalies

Spontaneous coronary artery dissection (SCAD) is an increasingly recognised cause of acute coronary syndrome, particularly in women. A 36-year-old Caucasian woman presented to our hospital with sudden onset chest pain and was diagnosed with a non-ST elevation myocardial infarction. Coronary angiography revealed mid and distal left anterior descending artery (LAD) dissection with distal LAD occlusion. A short segment of apical LAD filled late with incomplete opacification (Thrombolysis In Myocardial Infarction (TIMI) 1 flow). A decision was made to treat the patient conservatively, with subsequent resolution of dissection over the next 3 months. Our patient made a good clinical recovery with healing of her affected coronary vasculature on subsequent angiogram. The case illustrates that SCAD can be managed conservatively with antiplatelet agents, β-blockers, heparin and statins, if the patient is haemodynamically stable and coronary flow is adequate.

Topics: Adenosine; Adult; Anticholesteremic Agents; Antihypertensive Agents; Aspirin; Atorvastatin; Carbazoles; Carvedilol; Coronary Angiography; Coronary Vessel Anomalies; Diagnosis, Differential; Echocardiography; Electrocardiography; Female; Humans; Myocardial Infarction; Platelet Aggregation Inhibitors; Propanolamines; Purinergic P2Y Receptor Antagonists; Ticagrelor; Vascular Diseases

Polycystic ovarian syndrome (PCOS) affects 4% to 12% of women in reproductive age, representing a clinical condition that could predispose to cardiovascular diseases. We report a case of a 34-year-old woman with PCOS, presenting with chest pain, onset two days before, and ST segment-elevation myocardial infarction. She was not pregnant or in a postpartum state. Subsequent cardiac angiography revealed spontaneous left anterior descending coronary artery dissections, managed by conservative approach. The patient was discharged in medical therapy after 5days. This is the first observation of spontaneous coronary artery dissection occurring in a PCOS patient.

Topics: Acute Coronary Syndrome; Adenosine; Adult; Aspirin; Chest Pain; Coronary Angiography; Coronary Vessel Anomalies; Coronary Vessels; Electrocardiography; Female; Humans; Platelet Aggregation Inhibitors; Polycystic Ovary Syndrome; Purinergic P2Y Receptor Antagonists; Ticagrelor; Vascular Diseases