Coronary dissection

A profound complication of septal ablation is anterior Ml due to ethanol reflux from the septal perforator down the left anterior descending artery. This can be avoided by careful position of the balloon and angiographic monitoring. Other rare complications include coronary dissection, perforation, thrombosis, and spasm. 

Spontaneous acute coronary dissection after cocaine abuse has been reported (79). 

Davoli G. Spontaneous acute coronary dissection after 100. cocaine abuse in a young woman. Can J Cardiol 2003 19 297-9. 

Coronary dissection (Figures 8.39-8.41) This is an ACS that occurs suddenly, usually in young multiparous women, during the postpartum period, and is due to a collagen abnormality that favours dissection. The LAD is the most frequently involved artery and it may be dissected from its origin, which commonly causes a quite large infarction. It is even more severe because it occurs in an area with no previous ischaemia and in which collateral circulation has not been developed. 

The authors assert that spontaneous coronary dissection is a rare cause of acute coronary syndrome (ACS). Common risk factors for developing this condition were ruled out. No previous case of three-vessel coronary artery dissection related to carmabis use has been reported in the literature. However, previous reports have shoxvn a possible association between ACS and cannabis use. Cannabis is generally considered to be a drug of low toxicity but this and other cases highlight a need to exercise caution. 

Cardiac Aortic dissection, coronary artery vasospasm, pericarditis, valvular heart disease... 

Possible complications include massive myocardial infarction due to retrograde flow around the occlusion balloon, complete heart block, ventricular fibrillation, stroke, dissection of the left anterior descending artery, and right coronary artery thrombosis. Though high grade atrioventricular blockage occurs relatively frequently, procedural mortality rate is low (0-4%) and severe complications are rare and often avoidable (7-10). 

Spontaneous coronary artery dissection is an unusual cause of acute coronary syndrome. Only three other cases secondary to cocaine use have been described. 

Coronary artery dissection associated with cocaine is rare. The first case was reported in 1994 (87) and two other cases have been reported (88,89). 

A healthy 33-year-old man with prior cocaine use had a small myocardial infarction and, 36 hours later, having inhaled cocaine, developed a dissection of the left main coronary artery, extending distally to the left anterior descending and circumflex arteries. There was marked anterolateral and apical hypokinesis. 

Jaffe BD, Broderick TM, Leier CV. Cocaine-induced coronary-artery dissection. N Engl J Med 1994 330(7) 510-1. 110. 

Steinhauer JR, Caulfield JB. Spontaneous coronary artery dissection associated with cocaine use a case report and 112. brief review. Cardiovasc Pathol 2001 10(3) 141-5. 

Suspected cardiac source at high risk of recurrent embolism prosthetic mechanical heart valve, endocarditis, aortic dissection, acute coronary syndrome, overt congestive heart failure... 

A 29-year-old woman taking bromocriptine 5 mg/day postpartnm had a dissection of the left anterior descending coronary artery and needed emergency bypass grafting. She made a good recovery. 

Cohle SD, Lie JT. Dissection of the aorta and coronary arteries associated with acute cocaine intoxication. Arch Pathol Lab Med 1992 116(11) 1239 1. 

Eskander KE, Brass NS, Gelfand ET. Cocaine abuse and coronary artery dissection. Ann Thorac Surg 2001 71(1) 340-1. 

There are causes of infarctions other than acute atherothrombotic coronary occlusion. For example, prolonged vasospasm can induce infarction, and spontaneous dissection is becoming more commonly appreciated, especially in pregnant females. Other conditions (Box 44-1) can also cause the death of cardiomyocytes and lead to a biochemical signal of myocyte damage, but these entities should not be confused with myocardial infarction. Some of these injurious stimuli include (1) trauma that may precip-... 

Figure 7.4 (A) A patient with thoracic pain due to a dissecting aortic aneurysm. An ST-segment elevation in V1-V3 can be explained by the mirror pattern of an evident LVE (V6) due to hypertension. This ST-segment elevation has been erroneously interpreted as due to an acute coronary syndrome. As a consequence, fibrinolytic...

Figure 8.40 (A) Coronary angiography of a patient with dissection of the left main trunk. (B) The ECG shows an STE-ACS with ST-segment elevation from V2 to V6,1 and VL, and ST-segment depression in inferior leads. The ECG...

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