Endocrine Abstracts

Introduction: Spontaneous coronary artery dissection (SCAD) is a unique clinical entity gaining rapid recognition as an important cause of acute coronary syndrome (ACS). Cabergoline induced SCAD is exceedingly rare. We present a unique case of a young woman with multivessel SCAD on a background of Cabergoline use. To date, limited literature is available on cabergoline induced SCAD and we describe the first ever reported case in our country.

Case report: A 45-year-old woman presented to the Emergency Department with acute, heavy and severe chest pain of 30-minutes duration which radiated to her arms and back while driving. Her admission vital signs were within normal limits. Her physical exam was normal and she denied both systemic illness and recent stress. She has a background of hypercholesterolemia and a prolactinoma diagnosed 20 years prior. She was lost to follow up with her endocrinologist for several years but continued to take Cabergoline 500 mg weekly since her diagnosis. Her ECG was non ischemic. Initial troponin was 671 ngl/l (0-14ng/l). The remaining bloods including full blood count, liver, renal, bone, lipid profile and HBA1c were normal. She was started on Non-ST Segment Elevation myocardial infarction (NSTEMI) management. Her echocardiogram confirmed posterior-lateral and apical hypokinesis with impaired left ventricular ejection fraction 45%. Coronary angiogram confirmed a mid to distal left anterior descending (LAD) artery SCAD. Left circumflex artery also showed SCAD extending to the distal end of obtuse marginal branch. Based on angiographic review and her hemodynamic stability she was managed conservatively based on latest SCAD guidelines. Following endocrinology input her Cabergoline was ceased.

Conclusion: Clinicians should have a high index of clinical suspicion of SCAD in young women with ACS presentations. Cabergoline induced SCAD is an uncommon but important clinical entity which must be considered in those presenting with ACS while taking this medication.