scholarly journals Spontaneous Coronary Artery Dissections: A Systematic Review

2021 ◽  
Vol 10 (24) ◽  
pp. 5925
Author(s):  
Giovanni Teruzzi ◽  
Giulia Santagostino Baldi ◽  
Sebastiano Gili ◽  
Gianluca Guarnieri ◽  
Piero Montorsi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Clinical Presentation ◽  
Demographic Characteristics ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Nonobstructive Coronary Artery Disease ◽  
Artery Disease

Myocardial infarction with nonobstructive coronary artery disease due to spontaneous coronary artery dissection (SCAD) accounts for 5–8% of acute coronary syndrome (ACS) presentations. The demographic characteristics, risk factors, and management of patients with SCAD differ from those with atherosclerotic disease. The objective of this review is to provide a contemporary understanding of the epidemiology, pathophysiology, clinical presentation, and management of SCAD.

scholarly journals Spontaneous coronary artery dissection as a cause of ST-segment elevation myocardial infarction

2021 ◽  
Vol 29 ◽  
pp. 1-5
Author(s):  
Stéphany Bastos ◽  
Raquel Carbelin ◽  
José Francisco ◽  
Gustavo Matos ◽  
Evandro Matos Júnior ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Interventional Treatment ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Artery Disease

Spontaneous coronary artery dissection is an uncommon condition, and the patients’ clinical presentation is often underestimated due to few risk factors for atherosclerotic disease. Treatment must be individualized, with conservative therapy as the first option, respecting the criteria for referral for interventional treatment. We report a case of spontaneous coronary dissection, initially manifested as a non-ST segment elevation acute coronary syndrome, progressing to transmural infarction, in a young patient, with few risk factors for coronary artery disease, and give examples of difficulties related to the percutaneous approach.

Spontaneous coronary artery dissection in association with cabergoline therapy

2021 ◽  
Vol 14 (2) ◽  
pp. e240022
Author(s):  
Zia Saleh ◽  
Susan Koshy ◽  
Vaninder Sidhu ◽  
Andrea Opgenorth ◽  
Janek Senaratne
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Cardiac Risk ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Ergot Derivative

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognised cause of acute coronary syndrome. While numerous risk factors are associated with SCAD, one potential cause is coronary artery vasospasm. The use of cabergoline—an ergot derivative and dopamine agonist that may induce vasospasm—has been associated with SCAD in one other case report worldwide. Here, we describe SCAD in a 37-year-old woman on long-term cabergoline therapy with no other cardiac risk factors. Cabergoline-induced SCAD should be considered in patients presenting with an acute coronary syndrome who are treated with this medication.

scholarly journals P715 When "wait and see" is the best option: a case report of a spontaneous coronary artery dissection

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Castelo ◽  
T Silva ◽  
R Ramos ◽  
A Fiarresga ◽  
R Moreira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Luminal Narrowing ◽  
Angio Ct ◽  
Spontaneous Dissection

Abstract Introduction Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and is now being identified more frequently, in part because of increased awareness. Case report We present the case of a 63-year-old female, without cardiovascular risk factors or relevant past medical history. She complained of atypical chest pain in the last year. The patient was admitted due to acute chest pain at rest, hemodynamically stable, with unremarkable physical examination, including absence of heart failure signs. The EKG revealed a dynamic ST depression in leads V4-V6. The peak of high sensitivity troponin I was 13744pg/mL (ULN< 15.6) and CK 874U/l (ULN <168). The echocardiogram showed preserved left ventricular ejection fraction and hypokinesia of mid-apical segments of anterior wall. Considering the diagnosis of NSTEMI the patient underwent coronary angiography that revealed luminal narrowing of 70% in left main artery, 70% in proximal anterior descending artery (LAD) and 99% in first obtuse marginal. Given the absence of cardiovascular risk factors, the smooth angiographic appearance of coronary lesions and absence of calcium, we suspected of spontaneous dissection or vasculitis. Considering the absence of angina revascularization was delayed. A first coronary angio-CT confirmed the luminal narrowing and suggested a spontaneous dissection. Two weeks later the coronariography and the angio-CT were repeated with a significant improvement, showing only intermediate stenosis of proximal LAD. The additional imaging study revealed a 45mm ascending aortic dilation and a left primitive carotid stenosis without other vascular territory alterations, excluding fibromuscular dysplasia. The auto-immune study was unremarkable. With all these results it was assumed the diagnosis of a spontaneous coronary artery dissection and the patient was discharged asymptomatic under single antiplatelet therapy and Rivaroxaban. Three months later a new coronary angio-CT showed no significant coronary artery stenosis and the patient was asymptomatic. Discussion and conclusion The recognition of spontaneous coronary artery dissection is essential to the correct management of these cases because, unlike acute coronary syndrome due to atherosclerotic disease, the results of revascularization in these patients are suboptimal and conservative management is probably the best option. Abstract P715 Figure. angio-CT

Abstract 17378: Familial Spontaneous Coronary Artery Dissection - Evidence for Genetic Susceptibility

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kashish Goel ◽  
Marysia Tweet ◽  
Timothy M Olson ◽  
Joseph J Maleszewski ◽  
Rajiv Gulati ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Family Members ◽  
Case Series ◽  
Artery Dissection ◽  
High Morbidity ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
History Of

Background: Spontaneous coronary artery dissection (SCAD) typically presents as acute coronary syndrome in young women with no cardiovascular risk factors. It is associated with high morbidity and mortality, and is underdiagnosed. Despite this, risk factors and pathophysiology associated with SCAD are not completely understood. The objective of the present case series was to assess family history as a risk factor in patients with SCAD. Methods: We reviewed the medical records and questionnaires of 335 participants in the Mayo Clinic SCAD Registry for history of MI, SCAD or CAD in another family member. Coronary angiograms of all affected family members were reviewed by a senior interventional cardiologist. Results: We identified 4 familial cases of SCAD comprised of affected mother-daughter, identical twin sister, sister and aunt-niece pairs, implicating both recessive and dominant modes of inheritance. The mother-daughter pair also reported history of fatal MI in 3 maternal relatives including grandmother, great grandmother and great aunt. One of the affected twin sisters died of SCAD, which was confirmed on autopsy. None of the subjects had other potential risk factors for SCAD including extreme exercise, polycystic kidney disease, connective tissue disorder, peripartum status or diagnosed non-coronary fibromuscular dysplasia. The details of their demographics, risk factors, presentation, location of SCAD and management are presented in the table. Conclusions: This series is the first to identify a familial association in SCAD suggesting a genetic predisposition. Recognition of SCAD as a heritable disorder has implications for at-risk family members and furthers our understanding of the pathophysiology of this complex disease. Whole exome sequencing in these families provides a unique opportunity to identify the molecular underpinnings of SCAD susceptibility.

scholarly journals Update in Spontaneous Coronary Artery Dissection

2018 ◽  
Vol 7 (9) ◽  
pp. 228 ◽  
Author(s):  
Joseph Ingrassia ◽  
Daniel Diver ◽  
Aseem Vashist
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Acute Coronary Syndrome Patient ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Syndrome Patient ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Current State ◽  
Artery Disease

There has been increased awareness in the understanding and recognition of spontaneous coronary artery disease. Diagnosing this condition is of paramount importance as the treatment strategy differs greatly from traditional acute coronary syndrome patient. We review here the current state of management of spontaneous coronary artery disease.

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 Surgery is an option in evolving myocardial infarction induced by spontaneous coronary artery dissection: a case report

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Ghaitha Al Mahruqi ◽  
Hilal Alsabti ◽  
Mirdavron Mukaddirov
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Angiogram ◽  
Coronary Artery Dissection ◽  
Severe Chest Pain ◽  
Left Circumflex Artery ◽  
Coronary Syndrome

Abstract Background Spontaneous coronary artery dissection (SCAD) has emerged as one of the important yet rare causes of acute coronary syndrome that primarily affect young peripartum women without cardiovascular risk factors. Despite the recent improvements in diagnosis and recognition of the importance of SCAD, it remains poorly studied and there has been no consensus of opinion regarding its optimal management. Case summary A 29-year-old breastfeeding woman presented with 1-day history of severe chest pain radiating to the jaw and both shoulders. Cardiovascular examination, 12 leads electrocardiogram, and echocardiography were normal. Troponin levels were elevated; hence, coronary angiogram was done and showed type 2 SCAD of the left anterior descending artery (LAD). The patient was managed conservatively. The next day, she started again to complain of severe chest pain and her troponin levels continued to rise. Repeated coronary angiogram revealed progression of the previous LAD dissection. Another dissection was also noticed in the left circumflex artery. Chest pain recurred over the night and her troponin levels continued to rise. An emergency coronary artery bypass grafting (CABG) was performed. The patient was doing well postoperatively and was discharged home on Day 8. Discussion Our patient presented with acute ischaemic changes secondary to SCAD. The report illustrates the risk factors, pathogenesis, diagnostic work up, and the possible therapeutic options of SCAD, which include conservative management and CABG. The management varies depending on the clinical presentation and the extent of the coronary artery dissection.

scholarly journals Recurrent Spontaneous Coronary Artery Dissection in 4 Vascular Territories

2018 ◽  
Vol 45 (2) ◽  
pp. 106-109
Author(s):  
Nader Makki ◽  
Poorvi Dalal ◽  
Quinn Capers ◽  
Ernest Mazzaferri ◽  
Talal Attar
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Premenopausal Women ◽  
Rare Condition ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Coronary Events ◽  
Multiple Episodes

Spontaneous coronary artery dissection, a rare cause of acute coronary syndrome, is due to nonatherosclerotic coronary events and is probably underrecognized as a cause of myocardial infarction. The condition typically affects premenopausal women who are otherwise healthy. Among more than 1,200 reported cases, recurrent dissection has been described 63 times, and only 3 reports have documented multiple episodes of dissection involving different vascular territories. We present the case of a woman in her 30s who, over a 9-year period, presented 4 times with coronary dissection in different vascular territories. She was first treated conservatively, then with stents, and ultimately by means of coronary artery bypass grafting. In addition to this case, we discuss this rare condition and its management.

scholarly journals Atherosclerotic spontaneous coronary artery dissection (A-SCAD) in a patient with COVID-19: case report and possible mechanisms

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6 ◽  
Author(s):  
Remo Albiero ◽  
Giuseppe Seresini
Keyword(s):  
Coronary Artery ◽  
Vascular Inflammation ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Culprit Lesion ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Case Summary ◽  
Susceptible Patient ◽  
History Of

Abstract Background Spontaneous coronary artery dissection (SCAD) may be atherosclerotic (A-SCAD) or non-atherosclerotic (NA-SCAD) in origin. Contemporary usage of the term ‘SCAD’ is typically synonymous with NA-SCAD. COVID-19 could induce a vascular inflammation localized in the coronary adventitia and periadventitial fat and contribute to the development of an A-SCAD of a vulnerable plaque in a susceptible patient. Case summary In this report we describe a case of a COVID-19 patient with past cardiac history of CAD who was admitted for acute coronary syndrome (ACS). Coronary angiography demonstrated the culprit lesion in the proximal LAD that presented with a very complex and unusual morphology, indicative of an A-SCAD. The diagnosis of A-SCAD was supported by the presence of a mild stenosis in the same coronary segment in the last angiogram performed 3 years previously. He was successfully treated by PCI, had a favourable course of the COVID-19 with no symptoms of pneumonia, and was discharged from the hospital after two negative tests for SARS-CoV-2. Discussion A higher index of suspicion of A-SCAD is needed in patients with suspected or confirmed COVID-19 presenting with ACS. The proposed approach with ‘thrombolysis first’ for treating STEMI patients with suspected or confirmed COVID-19 infection could be unsafe in the case of underlying A-SCAD.

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