Case Report
Case Report and Review: Epicardial Coronary Artery Fibromuscular Dysplasia

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Fibromuscular dysplasia (FMD) of the epicardial coronary arteries is an uncommon entity. We describe the first published case of this condition presenting as a transient ischaemic attack due to thromboembolism from intracardiac thrombus secondary to silent myocardial infarction. We also present the first published case of epicardial coronary FMD with sparing of the renal arteries. This case provides further evidence that FMD of the epicardial coronary arteries frequently involves the mid to distal segments of the left anterior descending artery. A brief review of the literature on FMD is presented.

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Case Report

We present a case of a 34-year-old female who presented with right arm weakness and slurred speech that resolved within 24 h. She was diagnosed as having suffered a transient ischaemic attack. She had no symptoms of chest pain, dyspnoea, systemic influenza like illness, fevers, rash or arthritis.

The patient had a past history of schizophrenia. She had no other past medical history. She did not have a family history of cardiovascular disease or familial dyslipidaemia. She was an active tobacco

Discussion and Literature Review

We describe the first published antemortem case of FMD of the epicardial coronary arteries presenting as a thromboembolic transient ischaemic attack due to a silent myocardial infarct with associated intracardiac thrombus. We also believe that this is the first reported antemortem case of FMD of the epicardial coronary arteries with involvement of both lower limbs but with sparing of the renal arteries.

FMD is a non inflammatory, non atherosclerotic vasculopathy that can affect arteries or veins

Conclusion

We present a case of a 34-year-old woman with presumptive epicardial coronary artery FMD causing silent myocardial infarction with subsequent intracardiac thrombus and resultant thromboembolic transient ischaemic attack. This case further supports the likelihood that the typical angiographic appearance of epicardial coronary artery FMD is characterised by diffuse involvement of various segments of the LAD with the possible involvement of other coronary vessels. Significantly however, our case

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