Coronary Computed Tomographic Angiography for Noninvasive Follow-up of Spontaneous Coronary Artery Dissection

Clinical History A 55 year-old woman without known risk factors developed sudden-onset, 3/10 chest pressure in the setting of a recent family tragedy. Her electrocardiogram revealed apical and inferior nonspecific T-wave changes. Troponin-T peaked at 2.4 mg/dL. Emergent invasive coronary angiography was consistent with a distal left anterior descending coronary dissection without significant stenosis. Echocardiography confirmed globally preserved left ventricular function, but apical inferior wall hypokinesis. She was conservatively managed and discharged on dual-antiplatelet therapy, statin, beta-blockade, and ACE inhibitor. At a 1 month outpatient follow-up visit, she noted intermittent chest discomfort. Coronary CT angiography (CTA) was requested to exclude extension of the dissection.