Abstract
Byline: Mohammed Ali, Honolulu, HI; Todd Nagamine, Honolulu, HI; Witina Techasatian; Maan Kathryn Gozun, Honolulu, HI; Parthav Shah; Jason Kuniyoshi; Kevin Benavente, Honolulu, HI; James Zhang; Jihun Yeo, Honolulu, HI; Dipanjan Banerjee, HI Introduction: Methamphetamine use is not a traditional risk factor for spontaneous coronary artery dissection (SCAD). There have been several case reports suggesting an association between methamphetamine use and SCAD. Case: We present a case of a 50-year-old female with a history of hypertension, hyperlipidemia, stroke, and active tobacco use who presented with substernal chest pain radiating to the back and abdomen with associated dyspnea and diaphoresis. The patient was also taking warfarin for a prior history of deep venous thrombosis. Her serum 5th generation troponin level was elevated to a peak of 1135 ng/L, and a 12-lead EKG showed ST-elevations not meeting STEMI criteria (1mm in V3, 2mm in V4, and 0.5mm in V5). Coronary angiography showed a short section of SCAD type 1 involving the mid portion of the LAD with TIMI 3 flow. There was no significant atherosclerotic disease throughout any of the vessels. The patient was managed conservatively with medical therapy and had resolution of her pain. CT-angiography of the chest, abdomen and pelvis was performed to rule out dissection involving the aorta and its branches and was unrevealing. Urine toxicology screening returned positive for methamphetamine. Given a lack of other traditional risk factors aside from gender, the patient was diagnosed with SCAD secondary to methamphetamine use. Discussion: Traditional risk factors for SCAD include female sex, fibromuscular dysplasia, connective tissue disease, multiparity (our patient was parity 1), and exogenous hormone use. Methamphetamine use as well as prescription amphetamines have been associated with SCAD in several case reports. SCAD tends to occur in women with an absence of risk factors for coronary artery disease. However, even in patients with multiple risk factors for atherosclerosis and an absence of risk factors for SCAD, SCAD should not be excluded in the differential when a history of amphetamine use is elicited.