Type I Spontaneous Coronary Artery Dissection in a 33-Year-Old Male With Clinically Suspected Myopericarditis

We report a 33-year-old male with uncontrolled type II diabetes, and tobacco and marijuana use who presented with chest pain after a night of binge drinking and vomiting. ECG changes were consistent with acute pericarditis. Troponin levels were found to be significantly elevated and rising. The pati...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-05, Vol.15 (5), p.e38570
Main Authors: Nisson, Cullen, Hernandez Mato, Yeily, Lingappa, Nimisha, Abraham, James
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Antibodies
Autopsies
Biopsy
Cardiology
Cardiovascular disease
Connective tissue
Coronary vessels
Diabetes
Dissection
Electrocardiography
Emergency Medicine
Females
Hemoglobin
High density lipoprotein
Inflammatory bowel disease
Inflammatory diseases
Internal Medicine
Laboratories
Lupus
Males
Medical imaging
Pericarditis
Sarcoidosis
Ultrasonic imaging
Vein & artery diseases
Vomiting
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Summary:We report a 33-year-old male with uncontrolled type II diabetes, and tobacco and marijuana use who presented with chest pain after a night of binge drinking and vomiting. ECG changes were consistent with acute pericarditis. Troponin levels were found to be significantly elevated and rising. The patient was immediately treated with acetylsalicylic acid (ASA), morphine, nitroglycerin drip, and heparin drip. Echocardiogram showed preserved ejection fraction (EF) without effusion. Coronary angiography demonstrated a type I spontaneous coronary artery dissection (SCAD) of the mid-left anterior descending artery (LAD) without significant coronary artery disease. Diagnostic intravenous ultrasound (IVUS) confirmed a type I SCAD with penumbra and a minimal luminal area of 10 mm of the mid-LAD without significant luminal narrowing. Percutaneous intervention was performed with ultrasound-guided penumbra aspiration thrombectomy. Medical therapy was started with aspirin and ticagrelor, high-intensity statin, metoprolol tartrate, lisinopril, colchicine, and insulin. A biopsy or cardiac MRI was not performed due to the resolution of the patient's symptoms. We conclude that the development of a type I SCAD in this patient was multifactorial in nature, including clinically suspected acute myopericarditis, uncontrolled type II diabetes mellitus, and binge drinking associated with vomiting.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.38570