Novel Insights from Clinical Experience Cardiology 2014;128:282–284 DOI: 10.1159/000360574

Received: January 24, 2014 Accepted after revision: January 27, 2014 Published online: May 28, 2014

Subclavian Artery Dissection Presenting as Non-ST Elevation Myocardial Infarction Jean Touchan Martin Cerda Doug B. Chapman  University of Florida College of Medicine, Jacksonville, Fla., USA

Established Facts • Subclavian artery dissection is rare. • Most cases are iatrogenic or caused by trauma and are usually asymptomatic.

Novel Insights • We herein report the first case, to our knowledge, of subclavian artery dissection presenting as non-ST elevation myocardial infarction. • Treating the dissection with percutaneous intervention, as in our case, might help ameliorate the patient’s angina symptoms.

Abstract Spontaneous subclavian artery dissection is rarely reported. We report the case of a 55-year-old female who presented as an non-ST elevation myocardial infarction (NSTEMI) and was found to have a proximal left subclavian dissection. We provide an overview of current articles addressing the clinical

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features and treatments of subclavian dissection. To our knowledge, this is the first report of subclavian dissection presenting as an NSTEMI. © 2014 S. Karger AG, Basel

Introduction

Subclavian artery dissection (SAD) is rarely reported in the medical literature. SAD is usually associated with direct trauma, heart catheterization, or an anomalous Doug B. Chapman, MD 5th Floor, Ambulatory Care Center 655 West 8th Street, C35 Jacksonville, FL 32209 (USA) E-Mail Doug.chapman @ jax.ufl.edu

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Key Words Peripheral vascular disease · Acute coronary syndrome · Cardiovascular intervention

Fig. 1. Coronary angiogram showing an-

Fig. 2. SAD.

Fig. 3. SAD.

giographically patent arteries. 4 5

Fig. 4. Stent positioning in a subclavian ar-

tery. Fig. 5. Subclavian artery angiogram show-

ing a normal flow after the placement of 2 stents.

Case Report We describe the case of a 55-year-old female who presented from home with an acute onset of radiating substernal chest pain of an hour’s duration associated with shortness of breath, nausea, vomiting, and dizziness. The patient mentioned she had been at home prior to the presentation of her pain. She stated that the pain was radiating to her shoulders and moved up her back and into her jaw. Upon arrival to the emergency department, she was found to have hypertensive urgency, which was treated with intravenous nitroglycerin; this resulted in stabilization of her vital signs. Upon

SAD Presenting as NSTEMI

physical examination, she was found to have unequal pulses of 2+ bilaterally in the lower extremity and right upper extremity and 1+ in the left upper extremity. Cardiac examination was unremarkable for any murmurs, rubs, or gallops. She underwent a CT angiogram of the chest concerning for dissection, which showed focal dissection of the left proximal subclavian artery beginning just distal to the origin and extending 2.2 cm. Vascular surgery was consulted for possible surgical intervention; however, surgery was deferred to address the NSTEMI. Cardiac biomarkers were trended, resulting in the following initial values: total creatine kinase (CK), 101 U/l; CK-MB, 5.2 ng/ml, and troponin, 0.022 ng/ml. With serial cardiac enzymes, her troponin T peak was at 0.585 ng/ml (normal value

Subclavian artery dissection presenting as non-ST elevation myocardial infarction.

Spontaneous subclavian artery dissection is rarely reported. We report the case of a 55-year-old female who presented as an non-ST elevation myocardia...
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