The Case of Spontaneous Coronary Artery Dissection

摘要

A 45-year-old premenopausal Caucasian woman with no coronary risk factors presented to a rural community hospital complaining of subster-nal, burning chest pain. EKG on arrival demonstrated ST elevation in leads V2-V5. The first troponin level was 0.05. Arrangements were made for transfer to a cardiac treatment hospital. PHYSICAL EXAMINATION The cardiologist at the accepting hospital reviewed the EKG via fax. He and ordered initiation of half-dose thrombo-lytic therapy (TNK) along with Integri-lin and Lovenox. During transfer, the patient became pain free; she had a total of two hours of chest pain. On arrival, a repeat EKG demonstrated resolution of the ST elevations. Her troponin on admission was 108, CK 1400- with an MB fraction of 60. She remained stable in the coronary intensive care unit, with a planned cardiac catheterization the following morning.