A 38-year-old woman presented with a history of hypothyroidism treated with levothyroxine for 5, BMI 25.7 kg/m2, 7 days postpartum by cesarean section in another institution.
She consulted in a general hospital in Santiago for a 1-hour history characterized by sudden onset and maximum intensity retroseptic pain.
She was admitted without hemodynamic compromise, with normal cardiopulmonary examination.
Electrocardiogram (ECG) showed diffuse ST depression.
Medical management was initiated with aspirin, morphine and sublingual nitroglycerin. Cardiac enzymes and troponin levels were requested 0.43 mm. UmbS; admission tests showed: hemoglobin 14.9 g/dL, hematocrit 5
1.
A chest CT angiography was requested due to a high shunt, which ruled out pulmonary thromboembolism.
Patient remains with pain and control ECG evidence QS in AVL, qR in DI and changes in R wave amplitude in V4-V6.
Control cardiac enzymes with troponin > 50 ng/ml, CK 3.800 U/L and Ck-mb > 300 U/L. Coronary angiography shows dissection of the trunk extending from the left marginal artery proximal circumc.
Left anterior descending coronary artery (RAA) without lesions.
Aortic counterpulsation balloon was installed and bypassed with internal mammary artery (IMA) to ADA and saphenous vein graft to lateral Cx without incidents.
1.
Surgery was successful in the postoperative period, with withdrawal of vasoactive drugs and balloon counterpulsation at 48 h.
The control echocardiogram showed anterolateral unweighted akinesia with an ejection fraction of 42%.
Pharmacological control of heart failure was optimized with bisoprolol 1.25 mg per day, enalapril 5 mg per day, and atorvastatin 40 mg per day.
Located on the fifth day post-surgery.
It is controlled in a polyclinic 15 days after discharge, being in good general conditions, asymptomatic, without angina, functional capacity I, with the treatment already described, without breastfeeding.
