There was a history of chest pain associated with sweating, nausea and vomiting four days earlier for which he had not sought medical help. strongly positive. Coronary angiography showed dissection of the mid left anterior descending artery with normal circulation down the distal vessel. He was treated conservatively with anticoagulation and secondary prevention. He was in good health when seen in medical center four months later. Conclusion We spotlight the importance of a comprehensive approach at obtaining the correct diagnosis, input of different specialities and the fact that the presence of anti-cardiolipin antibodies is usually associated with coronary artery dissection in a middle-aged male patient whose presentation was stroke. Introduction Spontaneous coronary artery dissection (SCAD) is usually well explained in women, especially pregnant women. We present the case of a man with SCAD which was complicated by stroke due to a left ventricular thrombus. Case presentation A 56-year-old, Caucasian man presented with dysarthria and right-sided weakness to a district general hospital. There was a history of chest pain associated with sweating, nausea and vomiting four days earlier for which he had not sought medical help. He also experienced a history of lower limb deep vein thrombosis (DVT) four years ago. He was not taking any medications currently, and apart from his age there were no other cardiovascular risk factors. Examination revealed right-sided weakness but nothing else of notice. Electrocardiogram (ECG) showed sinus rhythm with anterior Q waves and MRI scan of the head showed a large left parietal lobe infarct and multiple smaller cerebral infarcts (Physique ?(Figure1).1). An echocardiogram showed anterior wall and apical akinesis with a large left ventricular mural thrombus (Physique ?(Figure2).2). Carotid Doppler measurements HSPC150 were all normal and blood assessments revealed strongly positive anti-cardiolipin antibodies. Open in a separate window Physique 1 MRI of brain showing a large left parietal and multiple smaller cerebral infarcts. Open in a separate window Physique 2 Two-dimensional echo-4 chamber view showing left ventricular apical thrombus. Due to our patient’s regional wall motion abnormalities, ECG changes and history, a coronary angiography was performed which showed a healed dissection of the mid left anterior descending artery with thrombolysis in myocardial infarction grade 3 (TIMI-3) circulation down the distal vessel (Physique Bifemelane HCl ?(Figure3).3). The rest of the coronary arteries were all normal. Open in a separate window Physique 3 Coronary angiography. Posteroanterior cranial view showing contained dissection of mid left anterior descending artery (LAD). In view of the above, a diagnosis of SCAD in association with anti-cardiolipin antibodies was made. SCAD had resulted in myocardial infarction leading to the development of a left ventricular thrombus which experienced embolized causing a stroke, which was his presenting complaint. The patient was anticoagulated with warfarin and secondary prevention instituted with angiotensin-converting enzyme (ACE) inhibitor, statin and beta-blocker. Due to a past history of DVT, it was made the decision that he should Bifemelane HCl continue taking warfarin for life. When examined in medical center four months later he had made an excellent neurological recovery and experienced no new symptoms. A repeat coronary angiogram 10 months after his initial presentation showed no new or progressive changes. Conversation Spontaneous coronary artery dissection is usually a rare but potentially fatal condition, explained mainly in young women, especially Bifemelane HCl in the peripartum period [1]. Other associations of SCAD explained in the literature are oral contraceptive use [2], antiphospholipid syndrome (APS) [3,4], connective tissue disorder [5], cocaine use [6] and physical exertion [7]. Antiphospholipid syndrome is usually characterized by the presence of antiphospholipid antibodies. The pathognomonic Bifemelane HCl feature of this condition is usually recurrent thrombosis in both the arterial and venous circulations, as well as the possible causative systems have already been evaluated [8] recently. With particular mention of SCAD, recent proof suggests Bifemelane HCl a wide-spread endothelial dysfunction in APS [9]. Coronary endothelial dysfunction could consequently play a significant part in the pathogenesis of SCAD and also other factors such as for example plaque or vasa vasorum rupture, localized vasculitis with eosinophilic infiltration, and improved shear tension. The preponderance of SCAD in being pregnant.