An unusual case of spontaneous multi vessel coronary artery dissection in an elderly patient: a case report

INTRODUCTION: Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndrome and sudden cardiac death. We report an unusual case of multi vessel spontaneous coronary artery dissection in an elderly woman with successful medical management. CASE PRESENTATION: A 65 year-old woman with hypertension and Parkinson's disease presented with sudden onset severe chest pain. Electrocardiogram showed ischemic ST-segment elevation in inferior and lateral leads. Urgent cardiac catheterization revealed focal dissections in four small caliber coronary arteries in right and left coronary systems including right posterior decending, posterolateral, obtuse marginal and septal arteries. Angiography demonstrated no significant atherosclerotic coronary artery disease. The patient was medically managed with Eptifibatide, Aspirin, Clopidogrel and β blocker since dissected vessels were not technically suitable for percutaneous coronary intervention. Antiparkinson medications were held as a potential cause of dissection. She responded well to medical management. CONCLUSION: Coronary dissection should be considered in all patients with an acute coronary syndrome. Medical management is an effective therapeutic option for the patient with small vessel dissections.