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Reminder of important clinical lesson
Case report
Recurrent acute coronary syndrome in a patient with spontaneous coronary artery dissection and fibromuscular dysplasia
  1. Taha Ahmed1,
  2. Tamoor Ahmed2,
  3. Samra Haroon Lodhi3 and
  4. Albert Chan4
  1. 1Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  2. 2Neurology, Mayo Hospital, Lahore, Pakistan
  3. 3Internal Medicine, King Edward Medical University, Lahore, Pakistan
  4. 4Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  1. Correspondence to Dr Taha Ahmed; tahaahmedfairview{at}gmail.com

Abstract

A 51-year-old woman who presented in June 2010 with acute coronary syndrome (ACS) and anterior wall motion abnormality on the echocardiogram but was found to have an insignificant angiogram. Eight years later she presented again with ACS and evidence of worsening cardiac wall motion affecting a similar territory; however, the angiogram revealing spontaneous coronary artery dissection of the distal left anterior descending artery. Extravascular screening revealed evidence of multifocal fibromuscular dysplasia. We suggest offering vascular screening for fibromuscular dysplasia in young women who present with ACS and normal angiograms, after weighing in risks and benefits.

  • interventional cardiology
  • cardiovascular system
  • healthcare improvement and patient safety

https://doi.org/10.1136/bcr-2020-235504

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    Footnotes

    • Twitter @TahaAhmedMDCcf

    • Contributors TA designed the study, performed the literature review, drafted the manuscript, revised the manuscript critically for important intellectual content and gave the final approval for the version published. TamA did the literature review and revised the manuscript. SHL performed the literature review and drafted the manuscript. AC reviewed the manuscript and suggested pertinent modifications.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.