Mysteriously Mysterious MI: Recurrent ACS Secondary to Spontaneous Coronary Artery Dissection Associated with Rheumatoid Arthritis.

Abstract

Background: Spontaneous coronary artery dissection (SCAD) is a rare but significant cause of myocardial infarction (MI), particularly in young females who often lack traditional cardiovascular risk factors. This condition is characterized by a tear in the coronary artery wall, which can lead to serious cardiac events.

Case Presentation: We present the case of a 36-year-old female who experienced recurrent episodes of myocardial infarction. Her clinical presentation included severe chest pain, ECG abnormalities, and angiographic findings consistent with coronary dissection. During her evaluation, she was also diagnosed with rheumatoid arthritis (RA), which was found to be an incidental but relevant finding in her medical history.

Results: Despite appropriate treatment, the patient continued to experience recurrent cardiac events, underscoring the chronic nature of her condition. The repeated episodes of MI were ultimately attributed to SCAD. The interplay of her chronic inflammatory state, autoimmune vasculitis, connective tissue abnormalities, and potential medication effects from RA were considered contributing factors to the development of SCAD.

Conclusion: This case underscores the challenges of managing spontaneous coronary artery dissection (SCAD) in a young woman with rheumatoid arthritis. It highlights the importance of thorough diagnostic evaluation and ongoing monitoring due to recurrent acute coronary syndrome episodes. Early identification and effective medical management, including dual antiplatelet therapy and anticoagulation, were crucial for favorable outcomes.