Zusammenfassung
Eine 51-jährige Frau ohne kardiovaskuläre Risikofaktoren wird mit massiven Brustschmerzen und gleichzeitigen ST-Streckenhebungen in den Ableitungen II, III, und aVF vorstellig. Nach einer umgehend verabreichten systemischen Thrombolysetherapie in einem peripheren Krankenhaus war die Patientin beschwerdefrei, weiters kam es auch zu einer ST-Strecken-Resolution. Eine im Intervall durchgeführte Koronarangiographie zeigte eine längerstreckige Dissektion in der peripheren linken Koronararterie. Aufgrund des kleinen Gefäßdurchmessers wurde eine konservative Therapie mit Acetylsalizylsäure, Clopidogrel, einem Statin und Betablocker gewählt. In der nach drei Monaten durchgeführten Kontrollangiographie zeigte sich die unverändert gebliebene Dissektion, die Patientin war wieder gut leistungsfähig und im Belastungstest ergab sich kein Anhalt für eine Ischämie.
Summary
A 51-year-old woman without cardiovascular risk factors experienced severe chest pain, accompanied by ST-segment elevation in lead II, III, AVF, and V4–V6. An immediately started thrombolytic therapy in a peripheral hospital successfully eliminated the cardiac symptoms and achieved complete ST-segment resolution. Subsequent cardiac angiography revealed a longitudinal spontaneous dissection in the distal part of the left anterior descending artery. Due to the small vessel size we decided on conservative therapeutic procedure with acetyl salicylamide, clopidogrel, statin, and beta blocker. Three months later, control angiography presented no resolution of the dissection and the patient showed excellent performance on stress test with no signs of ischemia.
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Mayr, A., Klug, G., Jaschke, W. et al. Persistent spontaneous dissection of the left anterior descending coronary artery after emotional pressure. Wien Klin Wochenschr 122, 515–517 (2010). https://doi.org/10.1007/s00508-010-1422-1
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DOI: https://doi.org/10.1007/s00508-010-1422-1