[Multiple spontaneous coronary artery dissections: a multidisciplinary challenge in diagnosis and treatment].

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome, primarily affecting young women without traditional cardiovascular risk factors. We report the case of a 57-year-old woman with obesity and a history of smoking, admitted for acute respiratory failure due to pneumonia, complicated by cardiac arrest. Elevated troponin levels, along with subsequent ECG and echocardiographic findings suggestive of previous myocardial ischemia, led to the indication for coronary angiography. The angiogram revealed severe three-vessel coronary disease with three distinct SCADs involving the left anterior descending, right coronary, and circumflex arteries. Advanced imaging, including whole-body positron emission tomography, revealed active systemic vasculitis. A multidisciplinary approach led to initiation of immunosuppressive therapy with corticosteroids and tocilizumab, alongside conservative cardiac management with dual antiplatelet therapy. At 1-year follow-up, the patient showed significant improvement in left ventricular function and normalization of inflammatory markers. This case highlights the diagnostic and therapeutic complexity of multiple SCADs, particularly in the context of underlying systemic inflammatory diseases, and underscores the importance of individualized treatment strategies and multidisciplinary collaboration.