A Rare Case of Spontaneous Coronary Artery Thrombosis in Acute Decompression Sickness

Document Type

Article

Abstract

Background: Decompression sickness (DCS) is rarely associated with venous (portal, mesenteric, femoral) and arterial (cerebrovascular) thrombosis. While DCS is known to result in ST elevated myocardial infarction (STEMI) from air embolism, no prior case of coronary artery thrombosis has been reported.

Case: A healthy 38-year-old male presented with acute severe chest pain while scuba diving 20 feet deep. Electrocardiogram onsite showed an inferior-posterior STEMI. Troponin was elevated. Coronary angiography (CAG) showed circumflex artery thrombosis (Figure). A thrombectomy was done with removal of a large thrombus.

Decision-making: While the acute lesions were initially thought to be from paradoxical emboli, a transesophageal echocardiogram showed no intra-atrial shunts. The lesions did not appear to be plaque ruptures. The patient had no coronary artery disease risk factors or a personal or family history of thrombophilia. The temporal relationship and CAG were consistent with acute primary thrombosis from DCS. He was therefore started on warfarin and aspirin.

Conclusion: This is the first reported case of spontaneous coronary artery thrombosis due to DCS. Possible mechanisms include hyperbaric effect on coagulation system via changes in factor VIIa levels, platelet function, endothelial dysfunction, and catecholamine levels. Identifying this association is pertinent as decisions on type of coronary intervention and use of anticoagulants depend on the etiology of the coronary lesions.

First Page

3304

DOI

10.1016/S0735-1097(24)05294-X

Publication Date

4-5-2024

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