Spontaneous Coronary Artery Dissection in End-Stage Renal Disease During Pre-Kidney Transplant Cardiac Assessment

Rezaei, Mahdokht; Bayani, Mohammad; Rasoolinejad, Vahid; Taghipour, Mohammad; Rahgodaz, Sadaf; Allami, Abbas

doi:10.22118/jsmj.2026.559771.4082

Spontaneous Coronary Artery Dissection in End-Stage Renal Disease During Pre-Kidney Transplant Cardiac Assessment

Document Type : Case Report

Authors

Mahdokht Rezaei ¹

Mohammad Bayani ²

Vahid Rasoolinejad ²

Mohammad Taghipour ²

Sadaf Rahgodaz ³

Abbas Allami ⁴

¹ School of Medicine,, Department of Cardiology, BouAli Hospital, Qazvin University of Medical Sciences, Qazvin, Iran

² School of Medicine, Department of Cardiology, BouAli Hospital, Qazvin University of Medical Sciences, Qazvin, Iran

³ Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran

⁴ Infectious Diseases Department, BouAli Hospital, Qazvin University of Medical Sciences, Iran

10.22118/jsmj.2026.559771.4082

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare and potentially fatal cause of acute coronary syndrome (ACS). It predominantly affects women under 50 and is often associated with fibromuscular dysplasia, the postpartum period, or connective tissue disorders. The occurrence of SCAD in patients with end-stage renal disease (ESRD) is exceedingly rare, with limited documentation in the literature. We report the case of a 44-year-old woman with a 4-year history of ESRD due to hypertension, who presented for a pre-renal transplant cardiac evaluation. During a dobutamine stress echocardiogram, the patient developed chest pain, frequent premature ventricular contractions, and new-onset regional wall motion abnormalities. Electrocardiography revealed ST-segment elevation in leads I and aVL, ST-segment depression in leads V2–V4, and an elevated blood pressure of 180/100 mmHg. Coronary angiography confirmed the diagnosis of SCAD. This case highlights the necessity of considering SCAD as a differential diagnosis in ESRD patients undergoing pre-transplant cardiac screening, particularly when stress test results are unexpected. Notably, this patient did not have autosomal dominant polycystic kidney disease (ADPKD), which is often linked with SCAD, adding to the uniqueness of this case. To our knowledge, this is one of the few reported instances of SCAD in an ESRD patient without ADPKD, underscoring the need for clinical vigilance to ensure transplant safety.

Keywords

Spontaneous Coronary Artery Dissection

Chronic Kidney Failure

Kidney Transplantation

Stress Echocardiography

Coronary Angiography

Subjects