A rare case report of spontaneous coronary dissection, with
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Case Report

A 40-year-old female patient was admitted to the emergency department of the Beneficência Portuguesa Hospital from Sao Jose do Rio Preto, presenting pain in the precordial region in tightening with irradiation to the left upper limb. She reported that the pain had started one hour before the entrance, during her work shift as a nursing technique. The pain, in its beginning, was maintained for approximately 10 minutes, with improvement for 20 minutes, returning with greater intensity and taking it to the search the emergency service.

The patient denied a history of hypertension, Diabetes mellitus, dyslipidemia and smoking, and was unable to report a family history. However, she reported an episode of sudden cardiac arrest three years earlier and presented with grade I obesity. She presented tortuosity of the coronary arteries and did not report migraine headaches. An electrocardiogram (Figure 1) and laboratory tests were performed, which were within the normal range. The enzymes CPK-MB and Troponin underwent significant changes in 14 h of analysis (from 1.9 to 5.0 and from 8.25 to 68.50, respectively), which indicated myocardial injury. She was medicated with 200 mg of ASA, 300 mg of Clopidogrel, 80 mg of Atorvastatin and 5 mg of sublingual Isosorbid Dinitrate, showing improvement of the condition. Due to the possible myocardial ischemia, the medical team decided to hospitalize it with prescription ASA, Ticagrelor, Enoxaparin, Trimetazidine, Ramipril, Atorvastatin and Metoprolol Succinate....