Large Coronary Intramural Hematoma Presenting as Acute Coronay Syndrome | Stephy Publishers

 


SOJ Medical and Clinical Case Reports - (SOJMCCR) | Stephy Publishers


Abstract

Isolated spontaneous coronary intramural hematoma is a unique subset of spontaneous coronary artery dissection that is characterized by a hemorrhage limited to the medial– adventitial layers, causing subsequent hematoma formation without visible intimal flaps.

It is infrequent and serious coronary vessel wall pathology, with poorly understood underlying pathogenic mechanisms. Affected individuals may present with a broad spectrum of symptoms ranging from acute coronary syndromes (ACS) to cardiogenic shock or even sudden cardiac death. The disease entity causes challenges in terms of both diagnostics and treatment strategy. We report a case of intramural coronary hematoma in a patient presenting with non ST-‐ segment elevation myocardial infarction.

Keywords

Intramural hematoma, Pathogenic mechanisms, Lumen compromise, Coronary blood, Clopidogrel

Introduction

Spontaneous coronary intramural hematoma is a unique and rare subset of spontaneous coronary artery dissection (SCAD), where a hemorrhage within the vessel wall is thought to be the underlying cause, leading to separation of the mural layers. The hematoma formation is limited to the medial–adventitial layers, and no flaps are visible when assessed with tomographic techniques.1,2 This serious condition usually presents as acute coronary syndrome (ACS), but symptoms may range from chest pain to cardiogenic shock or sudden death,1,2 depending on hematoma location, number of affected vessels, lumen compromise, and restriction of coronary blood flow. It is more frequent in young women, particularly in the peri and post-‐ partum period and with oral contraceptive use, and in young and middle-‐ aged patients without obvious cardiovascular risk factors.3,4 Management strategies may range from conservative medical treatment to percutaneous or surgical interventions depending upon the anatomy, extent of the hematoma and the clinical circumstances.5,6

Case Report

A 64-‐ year old female was admitted due to sudden onset of chest pain. Cardiovascular risk factors included hypertension. The ECG showed inverted T waves in inferior and low lateral leads and Troponin-‐ I was elevated (8,52 ng/ml). The patient was treated with a non-‐ STEMI medical treatment including aspirin, clopidogrel and low-‐ molecular weight heparin. The echocardiogram disclosed normal wall motions and preserved EF. A subacute coronary angiography showed an ectasic right coronary artery, where we detected a large intra mural hematoma starting from mid segment of the RCA. Unfortunately, neather the IVUS or the OCT is available in our hospital. We performed a coronary computed tomography for a more detailed evaluation of the morphological features of the vessel wall. We therefore decided to continue conservative treatment and intensified the medical therapy. She was discharged after one week in a stable clinical condition. A repeat angiogram three months later showed an improvement in the intra muralhematoma (Figures 1–4).

To read more #MedicalReports #ClinicalCases
https://www.stephypublishers.com/sojmccr/fulltext/SOJMCCR.MS.ID.000501.php


#Openaccessjournals
https://www.stephypublishers.com/

Comments

Post a Comment

Popular posts from this blog

Journal of Psychological Science and Research - (JPSSR) | Stephy Publishers

Image
  Journal of Psychological Science and Research - (JPSSR) | Stephy Publishers Journal of Psychological Science and Research is an international, peer reviewed open access journal, aims to publish articles on entire spectrum of the science of psychology. JPsSR acts as a source for the latest findings in social, developmental, cognitive, community, and health psychology, as well as behavioral neuroscience and biopsychology. The journal aims to publish high quality articles in the form of original research, review, case reports, mini-review, commentary, proceeding, editorial, etc. #Manuscriptsubmission https://www.stephypublishers.com/submit-manuscript.php More #Openaccessjournals https://www.stephypublishers.com/ # PsychologicalScience https://www.stephypublishers.com/psychological-science-and-research/
Read more
Image
 Resilience, Risk-Taking Behavior and Aggression among Female Volleyball Players – a Preliminary Study The aim of the current study is to investigate the level of risk-taking behavior, resilience and aggression in female volleyball players and the link between these psychological variables and coach’s performance ranking. A Romanian volleyball team ranked 7th out of 11 in the A1 league in the national championship (2022-2023 period) participated at the study. The Romanian adaptation of the Brief Resilience Scale, The Romanian adaptation of Makarowski’s Stimulating and Instrumental Risk Questionnaire, The Romanian adaptation of Makarowski's Aggression Questionnaire and Delphi method (evaluation of female volleyball players by coaches) were used. Analysis of the results reveals that athletes have a low level of perseverance (Go-Ahead factor), a low level of Foul play and a moderate to low level of assertiveness. Also, most athletes registered average or even low levels of resilience
Read more
Image
 Chemo stratigraphic Profile of a Reservoir in Well “X” of Field “Y” Offshore Southern Gabon - Stephy Publishers In a bid to evaluate the elemental and mineralogical content of reservoir samples from the “X” well in the “Y” oil field offshore Southern Gabon, analyses were performed using XRD and XRF. The log view profile of the result inferred that Na, Mg, and Calcite were absent in the shallower series of the reservoir sandstones studied, this observation implies that they are soluble ions that had eroded and refer to warm and humid paleoclimate and a depositional environment that is arid, which corresponds to the continental crust as their source. The plot of Ti and FeO+Mg discriminate the deeper series of the reservoir sandstone samples from the shallower samples. The lower series showed heavier values which implies their origin from Oceanic Crust. These are also the pre-salt facies while the shallower series were more of continental origin and represent the post-salt facies. https:
Read more