Isolated First Septal Perforator Spontaneous Coronary Artery Dissection Causing Acute Myocardial Infarction.

BACKGROUND

Isolated spontaneous coronary artery dissection (SCAD) of the first septal perforator (S1) is rare.

CASE SUMMARY: A 48-year-old man presented with chest pain after physical exertion. Coronary angiography demonstrated type 1 SCAD confined to S1. Cardiac magnetic resonance (CMR) confirmed a transmural septal infarction. The patient was managed conservatively with antiplatelet and beta-blocker therapy and experienced an uncomplicated recovery.

DISCUSSION: A limited number of cases of isolated S1 SCAD have been previously reported, predominantly affecting women and all managed conservatively. To our knowledge, this case represents the youngest reported male patient and appears to be the first reported case demonstrating CMR-confirmed transmural septal infarction secondary to type 1 S1 SCAD. Optimal long-term medical therapy remains undefined.

TAKE-HOME MESSAGES: SCAD should be considered in patients presenting with chest pain after physical or emotional stress. CMR is a valuable adjunct after angiography in cases of diagnostic uncertainty.