COEXISTENCE OF LMCA AND RCA OSTIAL STENOSIS IN YOUNG LADY : A RARE ANGIOGRAPHIC ENTITY

Abstract

Introduction:

Left main stem (LMS) disease is associated with significant morbidity and mortality. The classical presentation of LMS includes classical ischaemic chest pain and other prodromal symptoms, however the diagnosis is rather difficult and overlooked in women especially in younger age group due to its rare occurrence as they tend to have atypical presentation. We present a case of a young lady diagnosed as LMS Disease.

Case Report:

A 21-year-old healthy lady presented with history of left sided pricking chest pain for two weeks which aggravated on movement and breathing. One day prior to admission, she developed palpitation, vomiting and failure symptoms. She was tachypnoeic with poor oxygen saturation. Electrocardiogram (ECG) showed ST elevation on aVR with widespread ST depression at leads I, II, III, aVF, V2-V6. Bedside Echocardiography showed global hypokinesia. She was diagnosed as Left Main Stem Disease with Left Ventricular Failure and started on dual antiplatelet, anticoagulant and diuretics. In ward, she was referred to Institut Jantung Negara (IJN), Percutaneous Coronary Intervention (PCI) done and two stents inserted over ostial Left Main Coronary Artery (LMCA) and Right Coronary Artery (RCA). She is currently on dual antiplatelet therapy for 1 year.

Discussion:

The causes of LMCA Stenosis can be due to atherosclerotic or non-atherosclerotic. Coexistence of LMCA and RCA occlusion are higher in younger women population approximately 63% with mean age of 43.  It is due to different pathophysiology mechanism involved. The difference in vessels anatomy, oestrogen and histological properties of female gender which are more prominent for both LMCA and RCA and higher pressure in aorta causing intimal injury lead to ostial stenosis.

Conclusion:

Diagnostic dilemma in young women with subtle chest pain can be decreased with different approach. ECG and Bedside Echocardiography are the essential modalities to aid in diagnostic evaluation which help in early treatment.