scholarly journals Does thrombolytic therapy harm or help in ST elevation myocardial infarction (STEMI) caused by the spontaneous coronary dissection?

2015 ◽  
Vol 72 (6) ◽  
pp. 536-540 ◽  
Author(s):  
Zoran Jovic ◽  
Slobodan Obradovic ◽  
Nemanja Djenic ◽  
Zorica Mladenovic ◽  
Predrag Djuric ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Thrombolytic Therapy ◽  
Young Women ◽  
Anterior Wall ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Medial Segment

Introduction. Spontaneous coronary artery dissection (SCAD) is a very rare disease with poor prognosis. It mainly affects young women free of risk factors for coronary artery disease (CAD) and women during the peripartum period. The prognosis for myocardial infarction caused by SCAD is poor, management is often difficult and guidelines still missing. Case report. We presented a woman with acute myocardial infarction of anterior wall of the left ventricle, caused by spontaneous dissection of medial segment of the left anterior descending coronary artery. We treated the patient with thrombolytic therapy and performed coronary angiography after that. Finally we decided to do nothing more. Two years later we performed coronary angiography again and founded the coronary artery normal. We also analyzed 19 cases publiched from 1996 to 2012 when coronary artery dissection had been treated with thrombolytic agent. Analysis revealed only one case of 19, with complication after treating SCAD with thrombolysis. Conclusion. Sometimes, regarding myocardial infarction in young women with no risk factors for CAD, especially in young women in peripartum, we should think about SCAD. The presented case, like eight others, demonstrates that good clinical outcomes can be achieved with thrombolysis. In spite of all this, we still need more data to verify that thrombolysis does not have to harm the therapy for SCAD. For the time being thrombolytic therapy could be an option.

scholarly journals Spontaneous Coronary Artery Dissection/Intramural Haematoma in Young Women with ST-Elevation Myocardial Infarction: “It Is Not Always a Plaque Rupture Event”

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
George Kassimis ◽  
Athanasios Manolis ◽  
Jonathan N. Townend
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
Young Women ◽  
St Elevation Myocardial Infarction ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
St Elevation ◽  
Conventional Risk Factors

Spontaneous coronary artery dissection (SCAD) is an unusual, but increasingly recognized, cause of ST-elevation myocardial infarction (STEMI), especially among younger patients without conventional risk factors for coronary artery disease (CAD). Although dissection of the coronary intima or media is a hallmark finding, hematoma formation within the vessel wall is often present. It remains unclear whether dissection or hematoma is the primary event, but both may cause luminal stenosis and occlusion. The diagnosis of SCAD is made principally with invasive coronary angiography, although adjunctive intracoronary imaging modalities may increase the diagnostic yield. In STEMI patients, the decision whether to pursue primary percutaneous coronary intervention (PCI) or appropriate conservative medical therapy is based on clinical presentation, the extent of the dissection, the critical anatomy involvement, and the amount of ischaemic myocardium at risk. In this case report, we present two cases of young women with SCAD and STEMI, successfully treated with primary PCI. We briefly illustrate the characteristic aspects of the angiographic presentation and intravascular ultrasound-guided treatment. SCAD should always be considered in young STEMI patients without conventional risk factors for CAD with primary angioplasty to be required in patients with ongoing myocardial ischemia.

scholarly journals Spontaneous coronary artery dissection: Rare but challenging

2014 ◽  
Vol 71 (3) ◽  
pp. 311-316
Author(s):  
Biljana Putnikovic ◽  
Ivan Ilic ◽  
Milos Panic ◽  
Aleksandar Aleksic ◽  
Radosav Vidakovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Flow ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome

Introduction. Spontaneous coronary artery dissection (SCAD) is a rare cause of the acute coronary syndrome. It occurs mostly in patients without atherosclerotic coronary artery disease, carrying fairly high early mortality rate. The treatment of choice (interventional, surgical, or medical) for this serious condition is not well-defined. Case report. A 41-year old woman was admitted to our hospital after the initial, unsuccessful thrombolytic treatment for anterior myocardial infarction administered in a local hospital without cardiac catheterization laboratory. Immediate coronary angiography showed spontaneous coronary dissection of the left main and left anterior descending coronary artery. Follow-up coronary angiography performed 5 days after, showed extension of the dissection into the circumflex artery. Because of preserved coronary blood flow (thrombolysis in myocardial infarction - TIMI II-III), and the absence of angina and heart failure symptoms, the patient was treated medicaly with dual antiplatelet therapy, a low molecular weight heparin, a beta-blocker, an angiotensinconverting enzyme (ACE) inhibitor and a statin. The patient was discharged after 12 days. On follow-up visits after 6 months and 2 years, the patient was asymptomatic, and coronary angiography showed the persistence of dissection with preserved coronary blood flow. Conclusion. Immediate coronary angiography is necessary to assess the coronary anatomy and extent of SCAD. In patients free of angina or heart failure symptoms, with preserved coronary artery blood flow, medical therapy is a viable option. Further evidence is needed to clarify optimal treatment strategy for this rare cause of acute coronary syndrome.

scholarly journals Spontaneous Coronary Artery Dissection: A Rare Threat to Young Women

2012 ◽  
Vol 32 (4) ◽  
pp. e19-e26 ◽  
Author(s):  
Linda Griego Martinez
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Young Women ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Vigorous Exercise ◽  
Early Postpartum ◽  
St Elevation ◽  
Artery Disease

Spontaneous coronary artery dissection not associated with underlying coronary artery disease is rare. When the dissection does occur, it most often is manifested as an acute ST-elevation myocardial infarction in young women. Although the condition can occur in men, most often it involves women who are in their third trimester of pregnancy or the early postpartum period or are engaging in vigorous exercise. Because little is known about spontaneous coronary artery dissection in this population of women, recommendations for treatment are the same as for treatment of acute myocardial infarction associated with atherosclerotic coronary disease.

scholarly journals A Spontaneous Coronary Artery Dissection Case Noticed during a Primary PCI

2010 ◽  
Vol 2010 ◽  
pp. 1-3
Author(s):  
Ismail Dogu Kilic ◽  
Halil Tanriverdi ◽  
Harun Evrengul ◽  
Sukru Gur
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Artery Dissection ◽  
Primary Pci ◽  
Spontaneous Coronary Artery Dissection ◽  
Late Stent Thrombosis ◽  
Coronary Artery Dissection ◽  
Very Late Stent Thrombosis

Spontaneous coronary dissections (SCAD) can be asymptomatic or can manifest itself as any of the clinical spectrum of the ischemic heart disease. In this report, we present a 65 year old man presented with myocardial infarction in whom coronary angiography a nonocclusive SCAD was noticed in addition to a very late stent thrombosis and make a brief overview of the treatment for SCAD.

scholarly journals Defining the Cause of Postpartum Myocardial Infarction – Another Use for Optical Coherence Tomography

2020 ◽  
Author(s):  
Abdullah Alenezi ◽  
Jadan Alsaddah ◽  
Ossama Maadarani
Keyword(s):  
Myocardial Infarction ◽  
Optical Coherence Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Artery Dissection ◽  
Optical Coherence ◽  
Artery Wall ◽  
Coronary Artery Dissection ◽  
Middle Segment ◽  
St Elevation

Chest pain in a young postpartum female can have many causes; however, when associated with ST elevation on ECG, spontaneous coronary artery dissection (SCAD) should be high on the list. Coronary angiography remains the first step in delineating the coronary lesion in suspected cases of SCAD and optical coherence tomography (OCT) can be crucial when the angiographic appearance remains uncertain. We present a case of a young postpartum female with ST elevation myocardial infarction (STEMI). Coronary angiography revealed a dilated part of the middle segment of the left anterior descending (LAD) artery while intramural haematoma (IMH) of the coronary artery wall was found on OCT, which confirmed the clinically suspected diagnosis of SCAD.

scholarly journals Changing Incidence and Mechanism of Pregnancy‐Associated Myocardial Infarction in the State of California

2021 ◽  
Author(s):  
Sawan Jalnapurkar ◽  
Karen Huaying Xu ◽  
Zhiwei Zhang ◽  
C. Noel Bairey Merz ◽  
Uri Elkayam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
Mortality Rate ◽  
The State ◽  
Infant Mortality Rate ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Takotsubo Syndrome ◽  
Coronary Artery Dissection

Background The objective of this study was to evaluate the temporal trends in pregnancy‐associated myocardial infarction (PAMI) in the State of California and explore potential risk factors and mechanisms. Methods and Results The California State Inpatient Database was analyzed from 2003 to 2011 for patients with International Classification of Diseases, Ninth Revision ( ICD‐9 ) codes for acute myocardial infarction and pregnancy or postpartum admissions; risk factors were analyzed and compared with pregnant patients without myocardial infarction. A total of 341 patients were identified with PAMI from a total of 5 266 380 pregnancies (incidence of 6.5 per 100 000 pregnancies). Inpatient maternal mortality rate was 7%, and infant mortality rate was 3.5% among patients with PAMI. There was a nonsignificant trend toward an increase in PAMI incidence from 2003 to 2011, possibly attributable to higher incidence of spontaneous coronary artery dissection, vasospasm, and Takotsubo syndrome. PAMI, when compared with pregnant patients without myocardial infarction, was significant for older age (aged >30 years in 72% versus 37%, P <0.0005), higher preponderance of Black race (12% versus 6%, P <0.00005), lower socioeconomic status (median household income in lowest quartile 26% versus 20%, P =0.04), higher prevalence of hypertension (26% versus 7%, P <0.0005), diabetes (7% versus 1%, P <0.0005), anemia (31% versus 7%, P <0.0001), amphetamine use (1% versus 0%, P <0.00005), cocaine use (2% versus 0.2%, P <0.0001), and smoking (6% versus 1%, P =0.0001). Conclusions There has been a trend toward an increase in PAMI incidence in California over the past decade, with an increasing trend in spontaneous coronary artery dissection, vasospasm, and Takotsubo syndrome as mechanisms. These findings warrant further investigation.

scholarly journals BRIEF SUMMARY OF PATHOGENESIS, DIAGNOSIS AND MANAGEMENT OF SPONTANEOUS CORONARY ARTERY DISSECTION

2020 ◽  
Vol 30 (3) ◽  
pp. 136-140
Author(s):  
Algirdas Rėkus ◽  
Gediminas Jaruševičius
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Disease Risk ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Gold Standard Method ◽  
Coronary Syndrome

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). It was first described 80 years ago. Pathogenetic me­chanisms are most likely to be associated with inti­mas tear or bleeding vasa-vasorum, which resulting in intramural haemorrhage. SCAD typically occurs in young women who do not have coronary heart disease risk factors and who have acute coronary syndrome. Half of all SCAD presents with ST – ele­vation myocardial infarction (STEMI), while the rest with non – ST – elevation myocardial infarction (NSTEMI). The gold standard method for diagnosis is interventional coronary artery angiography. After the acute ischemic onset syndrome, most patients have a stable, benign clinical course, and eventually expe­rience spontaneous vessel wall healing. Therefore, conservative treatment (a watchful strategy) is recom­mended as the initial treatment. For the majority of cases as interventional and surgical treatment in most cases seems to be suboptimal. In this extremely com­plex situation, several novel and attractive coronary interventions have been proposed. The risk factors, pathogenesis theories, diagnosis, management, pro­gnosis of SCAD will be summarized in this review.

scholarly journals Recurrent spontaneous coronary artery dissection in a middle-aged male athlete patient: a case report

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
John J Fitzpatrick ◽  
Awsan Noman ◽  
Nicola Ryan ◽  
Dana K Dawson
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Young Women ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Angiogram ◽  
Coronary Artery Dissection ◽  
St Elevation

Abstract Background Spontaneous coronary artery dissection (SCAD) is a rare condition, mainly affecting young women. Cases in male patients are rare, especially with recurrence. Case summary A 59-year-old male non-elite athlete presented as an ST-elevation myocardial infarction following a 5-km run. Urgent coronary angiogram was normal, but cardiac magnetic resonance showed a myocardial infarction. Four years later, he experienced similar chest pain with no ST-elevation on electrocardiogram and a mild troponin rise. Urgent coronary angiogram was initially thought normal but subsequent close inspection confirmed a Type 2b SCAD. Cardiac magnetic resonance showed a small additional myocardial infarction contained within an area of acute myocardial oedema. Discussion Spontaneous coronary artery dissection is more common in young women compared to men and recurrent dissection has been rarely reported in the literature. Cohort studies have shown the rate of recurrent dissection to be 13–16%, but most of the patients in these cohorts are female. Poor data exists on the best treatment of SCAD in men, but given the presence of intramural thrombus, dual antiplatelet therapy was discontinued on the presumption that it may exacerbate an intramural bleeding process.

scholarly journals AB0498 CHARACTERISTICS AND OUTCOME OF CORONARY ARTERY LESIONS DUE TO POLYARTERITIS NODOSA: ANALYSIS OF A SINGLE CENTER COHORT IN CHINA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1547.2-1547
Author(s):  
C. Lai ◽  
L. Zhao ◽  
J. Zhou ◽  
D. Xu ◽  
X. Tian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
Polyarteritis Nodosa ◽  
Artery Dissection ◽  
Renal Infarction ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Lesions ◽  
Coronary Artery Dissection ◽  
Significant Difference

Background:Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that mainly affects medium-sized muscular arteries. The coronary artery could be affected. Some severe cases can lead to spontaneous coronary artery dissection (SCAD) and about 0.02% will die abruptly. Early diagnosis will improve prognosis, but relative studies are all case reports so far.Objectives:To investigate the clinical characteristics, risk factors and outcome of patients with polyarteritis nodosa (PAN) complicated with coronary artery lesions in China.Methods:Data of 158 patients with PAN who were admitted to Peking Union Medical College Hospital from September 1986 to September 2019 were retrospective collected. Data were analyzed and compared according to with and without coronary artery lesions due to PAN.Results:17 (10.8%) patients with PAN had the coronary artery lesions due to PAN. The age at coronary artery lesion was 36.9±10.3 years. 12 (70.6%) patients were male. There are not statistical differences between two groups in common risk factors of coronary arterial atherosclerosis including smoking, hypertension, diabetes mellitus and hyperlipidemia. Most of them are multi-vessel lesions (8 cases are triple-vessel lesions and 3 cases are bi-vessel lesions). Type of coronary artery affected is shown mainly in stenosis (13 cases). Myocardial infarction are shown in 8 cases (47.1%). Compared to patients without coronary artery lesions, patients with coronary artery lesions had less nervous system involvement (17.6% vs.46.8%) and elevated number of leukocyte (17.6% vs.56%). Besides, patients with coronary artery affected exhibit more cranial and carotid artery involvement(29.4% vs. 5.0%), renal artery involvement (41.2% vs.17.0%), coeliac artery involvement (58.8% vs.27.0%), new onset hypertension (47.1% vs.14.5%), renal infarction (27.3% vs.5.4%, ) and higher proportion of 2009 Five-factor score (FFS)≥2 (62.5% vs.15.6%). All patients with coronary artery lesions received at least moderate dose of prednisone and CTX except one refused medication. 3 cases underwent interventional therapy. Stent placement was performed on 2 of them, and in-stent restenosis was appeared in a patient one year later. 2 cases died,one for vascular rupture after coronary aneurysmsutrue plus coronary artery bypass grafting, another for myocardial infarction after stopping immunosuppressant therapy himself.Survival analysis showed patients with digital g angrene had poor prognosis though no significant difference(p=0.055).Conclusion:PAN with coronary artery lessions are not uncommon. These patients exhibit young age, more proportion of multi-vessel of coronary artery involvement, more combined involvments of other organ arteries and more severe disease.References:[1]Munguti CM, Ndunda PM, Muutu TM. Sudden Death From Spontaneous Coronary Artery Dissection Due to Polyarteritis Nodosa. Cureus, 2017;9 (10), e1737[2]Kritta nawong C, Kumar A, Johnson KW, et al.Conditions and Factors Associated With Spontaneous Coronary Artery Dissection (From a National Population-Based Cohort Study).Am J Cardiol, 2019; 123 (2): 249-253[3]Hwang J, Yang JH, Kim DK, Cha HS.Polyarteritis Nodosa Involving Renal and Coronary Arteries. J Am Coll Cardiol. 2012;59(7):e13Disclosure of Interests: :Chinchih Lai: None declared, Lin Zhao: None declared, Jiaxin Zhou: None declared, Dong Xu: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Fengchun Zhang: None declared

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