PMC9203732_01
Case timeline.
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F1
A timeline is shown in Figure 1.
(A) Depicts cardiac angiogram demonstrating occluded cardiac marginal arteries (arrows). (B) Depicts cardiac angiogram demonstrating dissected left main coronary artery (single arrow), occluded left anterior descending artery (double arrow), and occluded diagonal artery from the left anterior descending artery (triple arrow). (C,D) Reveal cardiac MRI with gadolinium enhancement with phase sensitive inversion recovery showing basal to mid transmural late gadolinium enhancement in the inferior and inferolateral walls (left circumflex artery territory) secondary to spontaneous coronary artery dissection.
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F2
Cardiac catheterization demonstrated multivessel spontaneous coronary artery dissection (SCAD) involving the ostial left main artery, first diagonal artery, obtuse marginal branches (M2 and M3 branches) and distal left anterior descending coronary artery (Figure 2). Cardiac magnetic resonance imaging confirmed left ventricular dilatation with severe left ventricular dysfunction, thin linear mid-wall delayed gadolinium enhancement in the septum, and focal transmural late gadolinium enhancement at the mid to base left ventricular inferior and inferolateral walls with hypokinesia secondary to SCAD (Figure 2).
(A) Transthoracic cardiogram demonstrating severely reduced LV function with severe biatrial enlargement. (B) Electrocardiogram demonstrating sinus tachycardia with second degree A-V block (Mobitz 1).
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F3
Transthoracic echocardiogram demonstrated worsening cardiac function with severe global hypokinesis of the left ventricle, mild to moderately reduced right ventricular systolic function, severe functional mitral regurgitation, moderate tricuspid regurgitation and pericardial effusion (Figure 3).