coronary dissection is more commonly reported in females and is an important
differential diagnosis for acute coronary syndrome. Accelerated
idioventricular rhythm has been reported before with reperfusion post myocardial
ischemia. We report a case of accelerated idioventricular rhythm in a patient
with spontaneous coronary artery dissection. A 45-year-old Caucasian female
presented with left sided chest pain radiating to the neck and palpitations.
Admission ECG showed accelerated idioventricular rhythm. Troponin I peaked at
0.5 ng/ml. Coronary angiography showed mid to distal left anterior descending
artery dissection with adequate distal flow. Patient was initially medically
managed with aspirin, metoprolol, intravenous heparin and eptifibatide
infusions but continued to have symptoms of unstable angina. She underwent
successful percutaneous coronary intervention with 2 drug eluting stents and
was discharged back home symptom free on dual platelet therapy. Spontaneous
coronary artery dissection is an important differential diagnosis for acute
coronary syndrome especially in younger females. Accelerated idioventricular
rhythm can be a presentation of coronary dissection and may indicate instability.
Early percutaneous coronary intervention should be considered in such patients.