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A case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site

BACKGROUND: Spontaneous coronary artery rupture (SCAR) is an extremely rare but life-threatening state. The aetiology and the pathologic findings remain to be fully elucidated. CASE SUMMARY: A 62-year-old woman, who had been on haemodialysis for 27 years, presented with chest discomfort worsening on...

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Autores principales: Fujimoto, Daichi, Takami, Mitsuru, Kozuki, Amane, Shite, Junya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764561/
https://www.ncbi.nlm.nih.gov/pubmed/31384915
http://dx.doi.org/10.1093/ehjcr/ytz135
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author Fujimoto, Daichi
Takami, Mitsuru
Kozuki, Amane
Shite, Junya
author_facet Fujimoto, Daichi
Takami, Mitsuru
Kozuki, Amane
Shite, Junya
author_sort Fujimoto, Daichi
collection PubMed
description BACKGROUND: Spontaneous coronary artery rupture (SCAR) is an extremely rare but life-threatening state. The aetiology and the pathologic findings remain to be fully elucidated. CASE SUMMARY: A 62-year-old woman, who had been on haemodialysis for 27 years, presented with chest discomfort worsening on deep inspiration that had been ongoing for the past 2 weeks. An echocardiogram and computed tomography showed diffuse pericardial fluid. ST elevation in the broad leads, especially in leads I, II, and aVF, and increased C-reactive peptide and Troponin I levels suggested pericarditis. The patient initially had a stable course with no medications. The chest symptoms disappeared and her vital signs were stable. On Day 13 after admission, however, she had a sudden cardiopulmonary arrest due to a cardiac tamponade. An emergency coronary angiography showed extravasation of the contrast into the epicardium from the branch of the circumflex artery. She was diagnosed with SCAR and underwent a successful coil embolization. However, she went into an irreversible coma due to the cerebral hypoxia. On Day 33, she died of pneumonia. An autopsy showed a rupture of the internal elastic layer of the coronary artery. However, no specific findings, such as aneurysm and dissection, were evident. The common atherosclerotic changes were observed. DISCUSSION: The stable condition lasting for over 2 weeks was a rare clinical course for SCAR. Long-term hypertension and dialysis would have caused the rupture of the coronary artery with common atherosclerotic changes. We should consider SCAR as one of the differential diagnoses when we observe pericardial fluid.
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spelling pubmed-67645612019-10-02 A case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site Fujimoto, Daichi Takami, Mitsuru Kozuki, Amane Shite, Junya Eur Heart J Case Rep Case Reports BACKGROUND: Spontaneous coronary artery rupture (SCAR) is an extremely rare but life-threatening state. The aetiology and the pathologic findings remain to be fully elucidated. CASE SUMMARY: A 62-year-old woman, who had been on haemodialysis for 27 years, presented with chest discomfort worsening on deep inspiration that had been ongoing for the past 2 weeks. An echocardiogram and computed tomography showed diffuse pericardial fluid. ST elevation in the broad leads, especially in leads I, II, and aVF, and increased C-reactive peptide and Troponin I levels suggested pericarditis. The patient initially had a stable course with no medications. The chest symptoms disappeared and her vital signs were stable. On Day 13 after admission, however, she had a sudden cardiopulmonary arrest due to a cardiac tamponade. An emergency coronary angiography showed extravasation of the contrast into the epicardium from the branch of the circumflex artery. She was diagnosed with SCAR and underwent a successful coil embolization. However, she went into an irreversible coma due to the cerebral hypoxia. On Day 33, she died of pneumonia. An autopsy showed a rupture of the internal elastic layer of the coronary artery. However, no specific findings, such as aneurysm and dissection, were evident. The common atherosclerotic changes were observed. DISCUSSION: The stable condition lasting for over 2 weeks was a rare clinical course for SCAR. Long-term hypertension and dialysis would have caused the rupture of the coronary artery with common atherosclerotic changes. We should consider SCAR as one of the differential diagnoses when we observe pericardial fluid. Oxford University Press 2019-08-05 /pmc/articles/PMC6764561/ /pubmed/31384915 http://dx.doi.org/10.1093/ehjcr/ytz135 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Reports
Fujimoto, Daichi
Takami, Mitsuru
Kozuki, Amane
Shite, Junya
A case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site
title A case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site
title_full A case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site
title_fullStr A case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site
title_full_unstemmed A case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site
title_short A case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site
title_sort case report of unusual clinical features of a spontaneous coronary artery rupture: pathologic findings in the rupture site
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764561/
https://www.ncbi.nlm.nih.gov/pubmed/31384915
http://dx.doi.org/10.1093/ehjcr/ytz135
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