Chang-Chieng Soon, Ting-Yu Chiu, Zhang-Wan Chiu, Chin-Yean Chen

Background: Spontaneous coronary artery dissection (SCAD) is an uncommon, nonatherosclerotic cause of acute coronary syndrome (ACS), most frequently affecting young women. Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital anomaly that may predispose individuals to exercise-induced myocardial ischemia and sudden cardiac death.

Case Summary: We report a 68-year-old woman with a history of diabetes mellitus, end-stage renal disease (ESRD), chronic hypertension, and congestive heart failure who presented with recurrent post-dialysis chest discomfort. Coronary angiography revealed SCAD in the proximal right coronary artery (RCA) with approximately 60% luminal narrowing and an anomalous origin of the left main coronary artery (LMCA) from the right coronary sinus (AAOCA). Given persistent symptoms and RCA dominance, the patient underwent PCI. Her postoperative course was uneventful, and she was discharged with outpatient follow-up.

Conclusion: The rare coexistence of SCAD and AAOCA highlights the importance of considering atypical coronary pathologies in patients with complex comorbidities and nonclassical angina. Timely diagnosis and appropriate intervention may be crucial in improving patient outcomes.

孫章權，邱定宇，邱讚旺，陳清淵

背景：自發性冠狀動脈剝離（SCAD）為一種罕見且非動脈粥樣硬化的急性冠心症（ACS）病因，常見於年輕女性。冠狀動脈異常起源（AAOCA）則為先天性心血管畸形，某些類型可能導致運動誘發性心肌缺血與猝死。 >病例摘要：本報告描述一名 68 歲女性，具糖尿病、末期腎病變、慢性高血壓與鬱血性心衰竭病史，長期接受血液透析。近月來反覆於透析結束後出現胸悶不適，近兩週症狀加劇。冠狀動脈攝影顯示右冠狀動脈近端有疑似 SCAD 之剝離變化，造成約 60% 狹窄，另左主幹起源異常，自右冠狀竇發出（AAOCA）。考量右冠為優勢血管且症狀持續，遂施行經皮冠狀動脈介入治療（PCI），術後恢復良好，安排門診追蹤。

結論：SCAD 與 AAOCA 同時存在實屬罕見，臨床上對於具多重共病且症狀非典型之患者，應提高對冠狀動脈異常病因的警覺。早期診斷與適切介入有助於改善預後。