Spontaneous dissection of the coronary and vertebral arteries post-partum case report and review of the literature 英文参考文献.docVIP

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Spontaneous dissection of the coronary and vertebral arteries post-partum case report and review of the literature 英文参考文献.doc

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Spontaneous dissection of the coronary and vertebral arteries post-partum case report and review of the literature 英文参考文献

Cenkowskietal.BMCPregnancyandChildbirth2012,12:122 /1471-2393/12/122 CASE REPORT OpenAccess Spontaneousdissectionofthecoronaryand vertebralarteriespost-partum:casereportand reviewoftheliterature MartaCenkowski1,MegandaSilva2,Kimberly-AnnBordun2,FarrukhHussain3,IainDCKirkpatrick4 andDavinderSJassal2,3,4,5* Abstract Background:Spontaneouscoronaryandvertebralarterydissectionsarerareeventsoccurringmostcommonlyin otherwisehealthywomenduringpregnancyorthepost-partumperiod. Casepresentation:Thisreportdescribesa35-year-oldfemalewhopresentedwithanacuteinferiorSTelevation myocardialinfarction7monthspost-partumsecondarytospontaneousdissectionoftheleftobtusemarginal coronaryartery.Despiteappropriatemedicaltherapywithdualanti-platelettherapy,thepatientpresentedfour weekslaterwithaspontaneousdissectionoftherightvertebralartery. Conclusion:Wereviewthepresentation,diagnosis,andmanagementofspontaneousdissectionsofthe vasculatureintheperi-partumperiod. Keywords:Spontaneousdissection,Vasculature,Pregnancy,Imaging Background the left second obtuse marginal (OM2) coronary artery, Spontaneous coronary and vertebral artery dissections with no percutaneous options for repair (Figure 1A). are rare events occurring most commonly in otherwise During the patient’s admission to CCU, the cardiac en- healthy women during pregnancy or the post-partum zymelevelsincludingcreatinekinaseandhighsensitivity period. troponinTpeakedat1340U/L and3702ng/L,respect- ively. Transthoracic echocardiography (TTE) demon- stratedmildhypokinesisofthebasalinferiorwallwitha left ventricular ejection fraction of 50-55%. As the hematologic and connective tissue disease work-up was negative, the patient was diagnosed with an acute infer- ior STEMI secondary to spontaneous dissection of the OM2. Thepatientwasappropriately dischargedondual antiplatelet therapy including ASA and Clopidogrel in- cludingbetablockadewithMetoprolol. Casepresentation A 35yearoldG2,P2female presentedwith atwo hour history of retrostern