A very fit young man was at the gym, working out, when he had the sudden onset of crushing, typically ischemic chest pain radiating to the left arm, with diaphoresis. Sudden severe substernal chest pressure radiating to left arm. No risks whatsoever.
BP 187/103
Cath: 70% RCA with thrombus and distal emobli. IVUS proved mimimal ruptured atheromatous plaque. Dissection flap seen. large artery could not be stented and distral thrombi could not be retrieved. Peak trop 16. Inf WMA.
I reviewed his coronary angiogram as well as intravascular ultrasound with interventional cardiologist Dr. Bachour. He has minimal atherosclerotic disease however had evidence of dissection flap in the mid right coronary artery most consistent with spontaneous dissection of the coronary artery. He was exercising and had elevated pressure and this may have been related to that. He denied substance abuse though he had previous history of elicit use. No obvious clinical features of Marfan syndrome.
The estimated left ventricular ejection fraction is 53 %
Regional wall motion abnormality-inferior hypokinetic .
Regional wall motion abnormality-inferolateral .
The estimated pulmonary artery systolic pressure is 27 mmHg + RA pressure.
BP 187/103
 |
| Debate about significance of inferior Q-waves |
 |
| 2nd ECG |
 |
| Next AM. T-wave now inverted in III |
Cath: 70% RCA with thrombus and distal emobli. IVUS proved mimimal ruptured atheromatous plaque. Dissection flap seen. large artery could not be stented and distral thrombi could not be retrieved. Peak trop 16. Inf WMA.
I reviewed his coronary angiogram as well as intravascular ultrasound with interventional cardiologist Dr. Bachour. He has minimal atherosclerotic disease however had evidence of dissection flap in the mid right coronary artery most consistent with spontaneous dissection of the coronary artery. He was exercising and had elevated pressure and this may have been related to that. He denied substance abuse though he had previous history of elicit use. No obvious clinical features of Marfan syndrome.
The estimated left ventricular ejection fraction is 53 %
Regional wall motion abnormality-inferior hypokinetic .
Regional wall motion abnormality-inferolateral .
The estimated pulmonary artery systolic pressure is 27 mmHg + RA pressure.
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