EXTENSION OF A SPONTANEOUS CORONARY-ARTERY DISSECTION DUE TO THROMBOLYTIC THERAPY

We describe a case of spontaneous coronary artery dissection in a 38-y ear-old woman presenting with anterior myocardial infarction who was i nitially treated with thrombolysis. During the administration of throm bolytics the clinical symptoms and the electrocardiogram (ECG) deterio rated, Coronary angiography revealed a major dissection in the proxima l left descending coronary artery, A spontaneous dissection was hypoth esized to have extended by thrombolytic-induced bleeding into the diss ected vessel wall, Therefore, we advocate that, especially in young fe male patients presenting with an acute myocardial infarction and witho ut cardiac risk factors, direct coronary angiography be considered, ra ther than thrombolytic therapy, in order to decide for the optimal the rapeutic strategy. (C) 1994 Wiley-Liss, Inc.