Author + information
- Received May 31, 2012
- Revision received June 9, 2012
- Accepted June 12, 2012
- Published online February 5, 2013.
- Ullrich Ebersberger, MD,
- Alex J. Lewis, MD, MBA,
- Brian A. Flowers, MD,
- Young Jun Cho, MD,
- William B. Wince, MD and
- U. Joseph Schoepf, MD
A 33-year-old Caucasian male with no medical history was referred for evaluation of an abnormal echocardiogram at an outside hospital after initially presenting with complaints of vague epigastric pain. The echocardiogram demonstrated a left ventricular ejection fraction (LVEF) of <20% with a dilated left ventricle. Cardiac catheterization (Online Video 1) revealed multivessel coronary artery dissection in the left anterior descending, second obtuse marginal (A), and right (B) coronary arteries. A cardiac magnetic resonance study showed diffuse global hypokinesis (Online Video 2) with a further deteriorated LVEF of 10% and layered thrombus (C) in the left and right ventricular apexes. Moreover, extensive, diffuse delayed enhancement (C and D) encompassed almost the entire right and left ventricle, indicating massive transmural infarction with only scarce remnants of viable myocardium in the basal anterolateral wall and septum. Further workup and serologic testing revealed a positive peri-nuclear antineutrophil cytoplasmic antibody titer as the only abnormal finding, suggesting polyarteritis nodosa as an association with possible causation for spontaneous dissection of multiple coronary arteries.
Dr. Schoepf receives research support from, and is a consultant to, Bayer, Bracco, General Electric, Siemens Bayer, Medrad, and Siemens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 31, 2012.
- Revision received June 9, 2012.
- Accepted June 12, 2012.
- American College of Cardiology Foundation