Female, 45 years old, with a history of chronic liver damage due to hepatitis C virus (Child A) and cesarean section 3 months before.
She developed angina at rest that resolved spontaneously.
She was admitted to the emergency service on the third day due to severe pain.
On admission, the patient presented clinical signs of low output and an electrocardiogram (ECG) showed ST-segment elevation.
Emergency hemodynamics showed anteroapical akinesia with mild decrease in left ventricular function, thinned left main coronary artery (LRTC), without significant stenosis, similar to a left coronary artery disease.
Intracoronary sonography showed a dissecting hematoma that compromised the TRCI, the anterior descending, circumflex and the right coronary from the middle third.
The lumen reduction reached up to 90% in the posterior descending artery.
Due to the extension of the disease, medical management with nitroglycerin, anticoagulation with nonsteroidal heparin (NFH) and antiplatelet therapy were decided.
The patient was monitored in a coronary care unit.
Subsequent echocardiogram revealed mild left ventricular systolic dysfunction (EF 46%), with no valvular insufficiency.
The patient developed angina at rest, but without hemodynamic compromise or electrocardiographic changes.
Pancytis (hepatitis) was diagnosed 30%, white blood cell count 1,530 and platelet count 62,600 during hospitalization.
Five days later, coronary angiography was repeated, which showed no changes, but in the presence of angina at rest, surgical myocardial revascularization was decided.
During surgery clear signs of coronary dissection were found in the three main vessels with normal distal coronary arteries.
Under cardiopulmonary bypass, with standard aortic and venous cannulation, moderate hypothermia and crystalloid cardioplegia, the three territories were revascularized with venous grafts, without incidents.
In the immediate postoperative period she presented hemorrhage requiring re-exploration, satisfactorily repairing a proximal anastomosis.
She had no other complications and was discharged in good condition.
In controls, he did not report angina.
