SPONTANEOUS CORONARY ARTERY DISSECTION IN A PATIENT WITH CUSHING DISEASE

• DOI: 10.1097/01.hjh.0000746712.23418.1c
• Publication Date: 2021-04-09T12:52:08Z
• Authors: Joana Tender Vieira; Bruno Besteiro; Ana Cunha; Luís Lemos; Ana Faceira; Pedro Marques; Jorge Almeida
• Keywords: Fibromuscular Dysplasia

Objective: Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction, caused by a non-traumatic and non-iatrogenic separation the arterial wall, especially amongst young women with no conventional cardiovascular risk factors. The most common factors associated SCAD are fibromuscular dysplasia (FMD), postpartum, multiparity, connective tissue disorders, systemic inflammatory conditions hormonal therapy. After extensive diagnostic workup some cases labeled as idiopathic. In literature reported aortic, cervical carotid dissections, but not SCAD, were Cushing syndrome. Design method: We describe 46-year-old woman past medical history disease (ACTH-producing pituitary tumor) treated surgically in 2009 that presented SCAD. Results: A nulliparous, hypertensive, obese non-smoker 2009, to emergency department retrosternal chest pain radiation left arm lasting for 30 minutes, nausea diaphoresis. No ischemic changes seen electrocardiogram serum high sensitive troponin I test rose pic level of, 96.3 ng/L (normal range <16 ng/L). Cardiac catheterization revealed diffuse distal stenosis anterior descending artery, compatible spontaneous type 2, Thrombolysis Myocardial Infarction (TIMI) II flow. patient was conservatively, anticoagulation during hospitalization single anti-aggregation without complications. Further investigations performed explore possible etiologies or associations Serum inflammatory, auto-immune immunologic workups negative. Angio-CT scan abdomen supra-aortic trunks showed signs FMD changes. Conclusions: Syndrome considered traditional factor As there dissections this entity causes excluded we hypothesized may have contributed fact, cortisol levels increase blood vessel fragility, making walls more vulnerable. To best our knowledge other syndrome