Chronic Coronary Artery Dissection Presenting as Heart Failure
The patient was a 31-year-old man with a past history of polycythemia vera, “enlarged heart” (1992), transient ischemic attack (1995), and decompensated heart failure (1997). He was referred for evaluation and management of suspected dilated cardiomyopathy. An ECG demonstrated Q waves in the anterolateral leads. Cardiac catheterization was performed. The image shown is a post-eroanterior cranial view of the left coronary artery. Note the radiolucent linear streaks in the left anterior descending coronary artery (LAD), diagonal branch (DIAG), and left circumflex branch (CX), consistent with chronic coronary artery dissection. The left ventriculogram revealed a dilated left ventricle with severe impairment in contractility.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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