A 47-year-old female, 10 minutes before admission to the hospital, felt pain between her shoulder blades, then a sharp stabbing recurrent chest pain that lasted 2-3 minutes in each episode. The pain was accompanied by shortness of breath and nausea.
She is an administrative worker in a hospital, under lots of stress lately.
CVD risk factors: smoker (3 pack-years), positive family history of CVD.
During the exam she suddenly lost conscience; ECG showed VF, and she was defibrillated.
ECG after DC shock: ST elevation in inferior and lateral leads.
Premedication (Brilique 180mg, tbl. Aspirin 300mg, LMWH 0.6 s.c) and Cath lab was activated.
Angiography showed SCAD type 2 on mid-distal LAD with a lumen reduction of 99%.
After returning from a cath lab, the patient is asymptomatic, and ECG changes are in regression.
50 minutes after angiography she complains of chest pain again. ECG shows ST elevation in inferior and lateral leads.
Cath lab was activated a second time. Angiography showed SCAD type 4.
After multiple balloon pre-dilatations with Artimes 1.25x15mm stents, Resolute Onyx 2.5×18 at 12 atm, Resolute Onyx 2.75×18 at 14 atm, Resolute Onyx 2.75×15 at 18 atm were implanted in LAD. TIMI3 flow was restored.
After the PCI patient was asymptomatic with ECG changes resolution.
She received DAPT and Bisoprolol 5mg; LMWH was discontinued after 2 days.
ECHO:
Day one:
Day four:
Day 26:
Author: prof. dr Svetlana Apostolović, Klinika za KVB, UKC Niš
Operator: prof. dr Zoran Perišić, Klinika za KVB, UKC Niš
1. Do you think the fast progression of scad is due to intensive DAPT?
2. What do you think about the PCI technique used?
3. Would you continue LMHW after stent implantation?
Epilogue; 60 days later.
