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A-33 | Title: Genetic Susceptibility to Spontaneous Coronary Artery Dissection: Insights from Monozygotic Twins

2024; Elsevier BV; Volume: 3; Issue: 5 Linguagem: Inglês

10.1016/j.jscai.2024.101510

2772-9303

Adam Habib, Reynaldo Gómez, Emily Dereszkiewicz, Nathaniel Kim, Javier Pineda,

Congenital Heart Disease Studies

Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of acute coronary syndrome (ACS) predominately affecting young to middle-aged women without traditional cardiovascular risk factors. Studies showing rare familial clustering of SCAD suggest some patients may share a genetic predisposition, which has since led to an increased interest in identifying susceptibility genes. Prior documented cases have shown familial clustering in three families involving monozygotic twins. In two of these three families, both monozygotic twins had SCAD. We present a new pair of SCAD cases in monozygotic twin sisters. (Case) A 56-year-old female with hypertension and familial history of her monozygotic twin sister with SCAD presented to the emergency department with substernal chest pain that radiated to both arms and back which persisted for 2-3 hours. Her systolic blood pressure was 190. She took a 50 mg dose of losartan at that time although admitted to inconsistent medication adherence. High sensitivity troponin peaked at 285. Lipid panel indicated a total cholesterol of 205, LDL at 129, HDL of 39, and triglycerides measuring 233. EKG showed sinus rhythm with atrial premature complexes and T wave inversions in the anterior, inferior, and lateral leads. Echocardiogram showed an ejection fraction (EF) 45% with hypokinesis in the basal inferior wall and basal inferior septal wall. It also showed akinesis in the mid inferior septal wall. Coronary angiogram revealed diffuse distal tapering in the posterior descending artery consistent with type IIb SCAD. Follow up EKG showed resolution of previous T wave inversions. CT angiogram of the head/neck and chest/abdomen/pelvis to evaluate for other arterial dissections was deferred due to patient concern of history of contrast-induced allergies. This case illuminates a genetic predisposition to SCAD, underscoring the role of genetics in its susceptibility This case highlights the need for further investigation of familial SCAD as there continues to be growing evidence for genetic susceptibilities.