Double Jeopardy: Spontaneous Coronary Artery Dissection and Stress-Induced Cardiomyopathy
- 1Biology, Loyola University Chicago, Chicago, USA
- 2Interventional Cardiology, Loyola University Medical Center, Maywood, USA
Abstract
Spontaneous coronary artery dissection (SCAD) and stress-induced cardiomyopathy (SIC), or Takotsubo syndrome, are distinct nonatherosclerotic causes of acute coronary syndrome that predominantly affect women and share physical and emotional triggers. Their simultaneous occurrence is uncommon and presents diagnostic and therapeutic challenges. We report a 74-year-old woman with hypertension and a prior cerebrovascular accident who presented with severe, persistent chest pain and a high-sensitivity troponin level of 9,143 ng/L. She was diagnosed with non-ST-segment elevation myocardial infarction and treated with intravenous heparin and nitroglycerin. Because of persistent symptoms and high-risk features, urgent coronary angiography was performed and demonstrated SCAD involving the apical left anterior descending coronary artery. Echocardiogram demonstrated apical ballooning with preserved basal contractility, raising concern for concomitant SIC. Myocardial infarction due to SCAD remained in the differential diagnosis. The patient was initially hemodynamically stable following catheterization with plans to obtain a cardiac MRI for further evaluation; however, on hospital day 2, she developed complete heart block that progressed to asystolic cardiac arrest, and she died despite prolonged resuscitative efforts. This case highlights the potential coexistence of SCAD and SIC, and emphasizes the importance of carefully evaluating patients with apparent Takotsubo cardiomyopathy for concomitant coronary pathology. It also illustrates the potential electrical and clinical complications associated with these overlapping conditions and supports a possible shared catecholamine-mediated or bidirectional pathophysiologic relationship.
Related
- A Bidirectional Relationship Between Spontaneous Coronary Artery Dissection and Stress-Induced Cardiomyopathy in a Perimenopausal Woman: A Case Report.
- Late coronary artery perforation with subsequent cardiac tamponade 3 days after primary percutaneous coronary intervention in a young woman with spontaneous coronary artery dissection—induced ST-elevation myocardial infarction: a case report
- Spontaneous coronary artery dissection presenting as myocardial infarction in a postmenopausal woman
- Double-Vessel Involvement: A Case Report of Simultaneous Left Anterior Descending Artery (LAD) and Right Coronary Artery (RCA) Spontaneous Coronary Artery Dissection Causing Acute Coronary Syndrome
- Recurrent Spontaneous Coronary Artery Dissection.
BibTeX
@article{gueyikian2026double,
title = {{Double Jeopardy: Spontaneous Coronary Artery Dissection and Stress-Induced Cardiomyopathy}},
author = {Gabriel Gueyikian and Amir Darki},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117254},
url = {https://europepmc.org/article/PMC/PMC13722521},
note = {CC BY},
}
RIS
TY - JOUR
TI - Double Jeopardy: Spontaneous Coronary Artery Dissection and Stress-Induced Cardiomyopathy
AU - Gabriel Gueyikian
AU - Amir Darki
PY - 2026
DA - 2026/09/30
JO - Cureus
DO - 10.7759/cureus.117254
UR - https://europepmc.org/article/PMC/PMC13722521
AB - Spontaneous coronary artery dissection (SCAD) and stress-induced cardiomyopathy (SIC), or Takotsubo syndrome, are distinct nonatherosclerotic causes of acute coronary syndrome that predominantly affect women and share physical and emotional triggers. Their simultaneous occurrence is uncommon and presents diagnostic and therapeutic challenges. We report a 74-year-old woman with hypertension and a prior cerebrovascular accident who presented with severe, persistent chest pain and a high-sensitivity troponin level of 9,143 ng/L. She was diagnosed with non-ST-segment elevation myocardial infarction and treated with intravenous heparin and nitroglycerin. Because of persistent symptoms and high-risk features, urgent coronary angiography was performed and demonstrated SCAD involving the apical left anterior descending coronary artery. Echocardiogram demonstrated apical ballooning with preserved basal contractility, raising concern for concomitant SIC. Myocardial infarction due to SCAD remained in the differential diagnosis. The patient was initially hemodynamically stable following catheterization with plans to obtain a cardiac MRI for further evaluation; however, on hospital day 2, she developed complete heart block that progressed to asystolic cardiac arrest, and she died despite prolonged resuscitative efforts. This case highlights the potential coexistence of SCAD and SIC, and emphasizes the importance of carefully evaluating patients with apparent Takotsubo cardiomyopathy for concomitant coronary pathology. It also illustrates the potential electrical and clinical complications associated with these overlapping conditions and supports a possible shared catecholamine-mediated or bidirectional pathophysiologic relationship.
SN - 2168-8184
ER -