Medevac from a cruise ship of a patient with spontaneous coronary artery dissection who presented with epigastralgia

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome that has been associated with peripartum and postpartum periods. It results from the separation of the layers of the arterial wall of the coronary artery with the subsequent formation of a false lumen. We report a case of a 54-year-old female who presented to the cruise ship’s medical facility complaining of epigastralgia and dizziness. Work up including an electrocardiography and cardiac profile was ordered. Results yielded a diagnosis of non-ST segment elevation myocardial infarction (NSTEMI). Treatment following American Heart Association recommendations including nitrates, clopidogrel and enoxaparin was given. After debarkation at sea and referral to a reference hospital, the patient was diagnosed with SCAD. Patient’s outcome was favorable and she was discharged home a few days after, despite being managed as a NSTEMI.