eP656 - Spontaneous Coronary Artery Dissection and Ulcerative Colitis: A Case Report

Purpose/Background: Spontaneous coronary artery dissection (SCAD) is a rare and often fatal cause of acute myocardial infarction. It most commonly occurs in young postpartum females without significant cardiovascular risk factors (Janssen). The true mechanism of SCAD is unknown. Associated risk factors include mixed connective tissue disorders, vasculitis, and inflammatory disorders. There are only a handful of reports highlighting SCAD in active inflammatory bowel disease (IBD). We present a case of a young male with untreated ulcerative colitis (UC), who suffered a myocardial infarction secondary to SCAD. The aim of this case report is to highlight that IBD, specifically UC, may predispose patients to spontaneous coronary artery dissection.Methods/Interventions: A 22-year-old African-American man with untreated UC and no cardiovascular risk factors presented with chest pain and EKG findings of anterior and inferior ST elevations. An emergency coronary angiography revealed a 100% occluded mid LAD. The diagnosis of SCAD was made with pathognomonic angiography findings of a longitudinal filling defect that generates a double lumen. In the recovery room, the patient suffered from ventricular tachycardia. CPR was started and ROSC was achieved. A subcutaneous ICD was placed prior to discharge.

Two weeks later, the patient returned with two days of abdominal distension, hematochezia, and anemia. He endorsed up to ten episodes of bloody diarrhea per day. He was diagnosed with ulcerative colitis a year ago, however, was only recently started on vedolizumab. On exam, he was distended, but not peritonitic. CT showed colitis with dilated loops of large and small bowel. Clinically, a differential diagnosis of fulminant or toxic colitis was considered. He stabilized with steroids and vedolizumab was resumed.Results/Outcomes: SCAD is an infrequent cause of acute coronary syndromes and may be associated with connective tissue disorders, vasculitis, and systemic inflammatory (Khlaed, Shahandeh). Other precipitating factors include stress, physical exertion, drug use, and hormonal imbalances (Saw, Hayes, Tokura). Srinivas et al were the first to document coronary artery dissection in IBD with their case report of a young female with Crohn’s. A national survey reported that RA, SLE, and Crohn’s disease are the most common autoimmune disease associated with SCAD (Krittawong). Our case report is the first to document SCD in a male patient with UC to our knowledge. UC may predispose patients to SCAD due to the release of proinflammatory cytokines causing intramural hemorrhage and thrombosis.Conclusion/

Discussion: This case elucidates that active systemic inflammatory processes such as UC may be a contributor to the development of SCAD. Further research is needed to deepen our understanding of the correlation between SCAD and UC and ideal treatment and prevention.