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Mailing Address: Francisco Juarez C. de Vasconcelos Filho • Av. Engenheiro Leal Lima Verde, 1471 casa 10 60833-520 – Fortaleza, CE Brazil E-mail: fjcvf@cardiol.br Received on 09/30/05 • Accepted on 01/12/06 A 34-year old, healthy man, reporting very strong, oppressive precordial pain, triggered by exertional exercise (soccer game), radiating to back and left arm, and associated to cold sweating for over 1 hour and with no alleviating factor. The patient denied risk factors for CAD. The patient looked for medical assistance only 2 days after the clinical event. Physical exam showed: BP: 120x 60mmHg; HR: 60b.p.m; Cardiac auscultation: regular rhythm, S4; Pulmonary auscultation: Normal. Electrocardiogram at admission showed: sinusal rhythm with pathological Q waves in lower leads (D2, D3 and aVF) (Fig. 1). Laboratory exams at admission showed: CPK971 IU/L (normal < 195 IU/L); CK-MB59.7 IU/L (normal< 25IU/L); troponin2.15 ng/ml (normal<0.1 ng/ml). Elective coronary angiography identifi ed ulcerated plaque with thrombus adhered to its surface in the initial third of right coronary artery (Fig. 2.1.A) and spontaneous dissection in middle third of left anterior descending (Fig. 2.1.B); Left ventriculography showed: inferior hypokinesia (+++/+4). Atrium Flyer 3,5x16mm stent implantation was carried out in left anterior descending (Fig. 3.1.A) and infusion of IIb/IIIA inhibitor + IV heparin + clopidogrel + aspirin was indicated, with recommendation of a re-study 48 hours after therapeutic regimen. Control coronariography showed dissolution of intracoronary thrombus (Fig. 3.1.B).

Dissecção espontânea de artéria coronária causando síndrome coronariana aguda