Endocrine Abstracts

Introduction: Spontaneous coronary artery dissection (SCAD) is an uncommon cause for acute coronary syndrome (ACS). It has been linked to many conditions such as physical exertion, emotional stress, fibromuscular dysplasia, autoimmune diseases. Recent studies suggest high prevalence of hypothyroidism in unselected consecutive patients with SCAD compared with a control group of ACS patients without SCAD with more distal dissections on curly vessels.

Case report: A 51 years old woman with no particular medical history except for hyperthyroidism diagnosed 5 months prior and treated with anti-thyroid drugs, presented to the emergency department for sudden constrictive chest pain following an unusual physical exertion. The EKG showed a regular sinus rhythm of 75 bpm and ST segment depression in the apico-lateral and inferior leads. Troponin levels were high (>40.000 ng/l) and the rest of the lab tests were unparticular. The patient received anti-ischemic treatment and was transferred to our department. At the admission to the intensive care unit, the patient was pain-free, and the EKG showed a sinus regular rhythm with complete regression of the previous patterns, she was then promptly transferred to the cath lab where coronary angiography was performed and showed a tubular dissection of a tortuous mid left anterior descending artery without flow limitation, concordant with type 2 SCAD. The decision then was to perform angioplasty with a DES covering the length of the diseased segment. The transthoracic echocardiography showed an akinetic apex, a left ventricle ejection fraction of 40% and an apical thrombus. The thyroid hormones dosage revealed a hypothyroidism, which was most likely iatrogenic due to the anti-thyroid drugs; subsequent dose lowering was put into effect for an eventual interruption. The patient was discharged with uneventful clinical course.

Conclusion: SCAD is still a topic of interest with unresolved pathophysiology and multiple factors that have been linked to it like thyroid disorder. More studies are needed in this context, which could potentially help elucidate the mechanisms involved in this phenomenon.