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Cite this article
Spontaneous Coronary Artery Dissection in a Woman on Fenfluramine
Division of Electrophysiology, Case Western Reserve University, Cleveland, OH
Division of Cardiology, East Tennessee State University, Johnson City, TN
Rev. Cardiovasc. Med. 2007, 8(1), 41–44;
Published: 30 March 2007
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, cardiogenic shock, and sudden cardiac death in women of reproductive age who have no traditional risk factors for coronary artery disease. The etiology, prognosis, and treatment of SCAD remain poorly defined. Coronary angiography is the gold standard for diagnosis. Management includes medical therapy and revascularization procedures using percutaneous intervention and coronary artery bypass grafting. Possible mechanisms of SCAD include rupture of atherosclerotic plaque or vasa vasorum, hemorrhage between the outer media and external lamina with intramedial hematoma expansion, and compression of the vessel lumen. We report a case of SCAD in a 39-year-old woman presenting with ST-elevation myocardial infarction midway through her menstrual cycle. Her medications included fenfluramine for obesity and hydrochlorothiazide, amlodipine, and atenolol for hypertension.
Spontaneous coronary artery dissection
Acute coronary syndrome