Spontaneous right coronary artery dissection.

Holbrook C, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-222130 Description A 41-year-old gravida 1 para 1 female with a medical history of hypertension and panic attacks presented to the emergency room with crushing chest pain radiating to her back for 2–3 hours. There was associated shortness of breath and anxiety but no other complaints. Initial evaluation confirmed normal vital signs as well as unremarkable physical examination, ECG, chest X-ray, CT chest and echocardiogram. Troponin was elevated (0.89 ng/mL) and she was admitted for cardiac monitoring, and was started on aspirin and metoprolol. She continued to have ongoing chest discomfort and rising cardiac enzymes along with new inferior lead T-wave inversion on ECG. Nitroglycerin, clopidogrel and fondaparinux were administered and ultimately the decision was made to perform cardiac catheterisation. Coronary angiography revealed 80% mid-right coronary artery stenosis secondary to spontaneous coronary artery dissection (Figure 1A, B) and a bare-metal stent was deployed with restoration of normal blood flow