RESUMO
Spontaneous coronary artery dissection and vertebral artery dissection are rare, life-threatening conditions. The pathophysiology of spontaneous coronary artery dissection during the peripartum period is poorly understood. We present a case of spontaneous multivessel dissection in a 32-year-old postpartum woman who presented with neck and chest pain. The patient's coronary and vertebral artery dissections were diagnosed with use of multiple imaging methods, and dissection of the internal mammary artery was discovered during surgery. The patient underwent successful coronary artery bypass grafting and remained asymptomatic 2 years later. To our knowledge, this is the first report of simultaneous coronary, vertebral, and internal mammary artery dissection in a postpartum woman. Early recognition and treatment is crucial, given the high mortality rate associated with spontaneous dissection.
Assuntos
Dissecção Aórtica/etiologia , Aneurisma Coronário/etiologia , Artéria Torácica Interna , Transtornos Puerperais/etiologia , Dissecação da Artéria Vertebral/etiologia , Adulto , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/cirurgia , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/cirurgia , Angiografia Coronária , Ponte de Artéria Coronária , Eletrocardiografia , Feminino , Humanos , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/cirurgia , Parto , Período Pós-Parto , Gravidez , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/cirurgia , Veia Safena/transplante , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Dissecação da Artéria Vertebral/diagnóstico , Dissecação da Artéria Vertebral/cirurgiaRESUMO
Safety of performing adenosine myocardial perfusion stress testing as early as 24 h after acute uncomplicated myocardial infarction is not known. We evaluated 31(14 females and 17 males, average age 72, range 46-89 years) consecutive patients with uncomplicated myocardial infarction, who underwent adenosine myocardial perfusion stress imaging, 24-72 h after infarction for risk stratification. Adenosine was infused at a rate of 140 microg/kg/min for 6 min. Twenty patients were presented with non-ST-elevation myocardial infarction. Eleven patients were admitted with acute ST-elevation myocardial infarction. Patients were monitored for signs of complication during and immediately after the stress test. The average time from admission to performance of stress tests was 51 +/- 19 h, ranging from the minimum of 24 h to maximum 72 h. No complications related to adenosine infusion were detected. In conclusion, our data suggest that a further large study of early adenosine myocardial perfusion SPECT imaging may be safe in a carefully selected group of patients after uncomplicated myocardial infarction.