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Santosa Y, Yuwono A. Successful Percutaneous Coronary Intervention in a Patient With aVR ST-Segment Elevation Myocardial Infarction Due to Spontaneous Atherosclerotic Coronary Artery Dissection. Cureus 2021; 13:e19545. [PMID: 34917430 PMCID: PMC8668389 DOI: 10.7759/cureus.19545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/26/2022] Open
Abstract
Chest pain is a common clinical symptom that leads to a patient's admission to the emergency department, which may be caused by acute coronary syndrome (ACS). Electrocardiography (ECG) is a useful tool for diagnosis, risk stratification, and treatment response monitoring in clinical practice. The coronary angiography should be done in ACS, which may detect spontaneous atherosclerotic coronary artery dissection (SCAD) that should be followed by urgent revascularization. We present a case of a 55-year-old male with the augmented Vector Right (aVR) ST-segment elevation myocardial infarction due to spontaneous atherosclerotic coronary artery dissection. The patient had a good outcome after we performed early coronary angiography, followed by the percutaneous coronary intervention (PCI).
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Affiliation(s)
- Yudistira Santosa
- Internal Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, IDN
| | - Angelina Yuwono
- Internal Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, IDN
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102
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Matsuura S, Otowa K, Maruyama M, Usuda K. Successful revascularization with percutaneous coronary intervention using a combination of the subintimal transcatheter withdrawal technique and coronary artery fenestration for spontaneous coronary artery dissection. Clin Case Rep 2021; 9:e05045. [PMID: 34765216 PMCID: PMC8572350 DOI: 10.1002/ccr3.5045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/11/2021] [Accepted: 10/20/2021] [Indexed: 11/10/2022] Open
Abstract
The combination of the STRAW technique and coronary artery fenestration using a cutting balloon could be effective in SCAD patients, especially with dissection to the distal end of the coronary artery.
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Affiliation(s)
- Shintaro Matsuura
- Department of CardiologyToyama Prefectural Central HospitalToyamaJapan
| | - Kanichi Otowa
- Department of CardiologyToyama Prefectural Central HospitalToyamaJapan
| | - Michiro Maruyama
- Department of CardiologyToyama Prefectural Central HospitalToyamaJapan
| | - Kazuo Usuda
- Department of CardiologyToyama Prefectural Central HospitalToyamaJapan
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103
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Aslam A, Stojanovska J, Khokhar US, Weinberg RL, Ganesh SK, Labounty T, Sutton NR, Patel S. Spontaneous Coronary Artery Dissection: An Underdiagnosed Clinical Entity-A Primer for Cardiac Imagers. Radiographics 2021; 41:1897-1915. [PMID: 34652974 DOI: 10.1148/rg.2021210062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of myocardial infarction in young and middle-aged women that has gained increasing awareness in recent years. Its diagnosis presents a challenge. Invasive coronary angiography is the primary imaging modality for diagnosing SCAD; however, it carries risk in these patients, who have an increased predisposition to complications. Advances in CT technology enable robust noninvasive evaluation of the coronary arteries at low radiation doses and have been increasingly utilized for the diagnosis or resolution of SCAD, in hemodynamically stable patients or when diagnosis of SCAD is uncertain at invasive angiography, particularly in proximal vessels. However, criteria for the diagnosis of SCAD with use of coronary CT angiography (CCTA) have not been currently established, and sensitivity and specificity for diagnosis have not yet been defined. The appearance of SCAD at CCTA can be subtle and can be missed, especially in distal small-caliber coronary arteries; hence utilization of other noninvasive imaging multimodalities may help solve this diagnostic challenge. Accurate and prompt diagnosis is vital, as management of SCAD differs significantly from that of traditional atherosclerotic acute coronary syndromes, with conservative management preferred for the majority of SCAD patients, and invasive treatment reserved for those with ongoing or recurrent ischemia, heart failure, or hemodynamic compromise. The goal of this review is twofold: (a) to discuss the potential role of CCTA in the diagnosis of SCAD, and (b) to discuss the role of multimodality imaging that may improve diagnostic yield, guide management, and enable subsequent surveillance. An invited commentary by Ordovas is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Anum Aslam
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Jadranka Stojanovska
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Usman S Khokhar
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Richard L Weinberg
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Santhi K Ganesh
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Troy Labounty
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Nadia R Sutton
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
| | - Smita Patel
- From the Divisions of Cardiothoracic Radiology (A.A., J.S., S.P.), Cardiovascular and Internal Medicine (R.L.W., S.K.G., T.L.), and Interventional Cardiology (N.R.S.), Frankel Cardiovascular Center, and Department of Human Genetics (S.K.G.), Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109; and Division of Interventional Cardiology, Henry Ford Allegiance Health Hospital, Jackson, Mich (U.S.K.)
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104
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Rabbani NUA, Mansoor K, Ranavaya MI, Mader J, Lester MD. Spontaneous Coronary Artery Dissection of an Anomalous Right Coronary Artery in a Young Male. Cureus 2021; 13:e16924. [PMID: 34513495 PMCID: PMC8418587 DOI: 10.7759/cureus.16924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/05/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a tear in the coronary artery layers that presents clinically as an acute coronary syndrome (ACS), ventricular arrhythmias, or sudden cardiac death (SCD). It is uncommon for young healthy males with no comorbid conditions to have SCAD. We report an interesting case of SCAD in an anomalous right coronary artery (RCA) in a young 33-year-old male. The patient presented with episodes of midsternal chest pain and had elevated troponins on laboratory workup. A left heart catheterization revealed anomalous RCA, originating from the left aortic sinus. The left heart catheterization also demonstrated a SCAD of the anomalous RCA. Cardiothoracic surgery was consulted, and the patient had placement of saphenous vein graft to the proximal RCA. While this patient's presentation of ACS in the setting of SCAD is relatively common, it was atypical due to gender and lack of precipitating stressors. One of the risk factors this patient did have was the anomalous RCA arising from the left aortic sinus. There is scarce literature involving guidance for therapeutic intervention for RCA ostial lesion, let alone an anomalous one. Although coronary artery bypass grafting (CABG) remains the most clinically sound decision, in this case, further development of guidelines for RCA lesions would aid in decision-making.
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Affiliation(s)
- Noor Ul Ann Rabbani
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Kanaan Mansoor
- Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | | | - Jason Mader
- Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Melissa D Lester
- Cardiology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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105
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Tanabe J, Kagawa Y, Endo A, Tanabe K. Spontaneous coronary artery dissection associated with psychological stress. BMJ Case Rep 2021; 14:e245414. [PMID: 34433541 PMCID: PMC8388295 DOI: 10.1136/bcr-2021-245414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Junya Tanabe
- Cardiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yuzo Kagawa
- Cardiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Akihiro Endo
- Cardiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kazuaki Tanabe
- Cardiology, Shimane University Faculty of Medicine, Graduate School of Medicine, Izumo, Japan
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106
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Adlam D, Tweet MS, Gulati R, Kotecha D, Rao P, Moss AJ, Hayes SN. Spontaneous Coronary Artery Dissection: Pitfalls of Angiographic Diagnosis and an Approach to Ambiguous Cases. JACC Cardiovasc Interv 2021; 14:1743-1756. [PMID: 34412792 PMCID: PMC8383825 DOI: 10.1016/j.jcin.2021.06.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/07/2021] [Accepted: 06/08/2021] [Indexed: 01/28/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is a pathophysiologically distinct cause of acute coronary syndromes (ACS). It is increasingly recognized that optimal management is different from that for atherosclerotic ACS and that a SCAD diagnosis has specific long-term prognostic and therapeutic implications. Accurate diagnosis is therefore essential to ensure the best treatment of patients. At present this relies on the recognition of typical features of SCAD identified on invasive coronary angiography. Although most SCAD can be readily distinguished angiographically from alternative causes of ACS, false positive and false negative diagnoses remain common. In particular, sometimes non-SCAD presentations, including atherothrombosis, takotsubo cardiomyopathy, coronary embolism, coronary vasospasm, contrast streaming, and myocardial infarction with nonobstructive coronary arteries, can mimic angiographic features usually associated with SCAD. The authors present the combined experience from European and US SCAD referral centers reviewing the classical angiographic appearances of SCAD, presenting potential diagnostic pitfalls and exemplars of SCAD mimickers. The authors further review the benefits and limitations of intracoronary imaging in the context of SCAD. Finally, the authors discuss the investigation of ambiguous cases and an approach to minimize misdiagnosis in difficult cases.
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Affiliation(s)
- David Adlam
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom.
| | - Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Deevia Kotecha
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Praveen Rao
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Alistair J Moss
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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107
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Khandelwal A, Bakir M, Bezaire M, Costello B, Gomez JMD, Hoover V, Nazir NT, Nichols K, Reisenberg A, Rao A, Sanghani R, Tracy M, Volgman AS. Managing Ischemic Heart Disease in Women: Role of a Women's Heart Center. Curr Atheroscler Rep 2021; 23:56. [PMID: 34345945 PMCID: PMC8331213 DOI: 10.1007/s11883-021-00956-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Heart centers for women (HCW) were developed due to the rising cardiovascular morbidity and mortality in women in the United States in the early 1990s. Our review encompasses the epidemiology, risk factors, diagnostic strategies, treatments, and the role of HCW in managing women with ischemic heart disease (IHD). RECENT FINDINGS HCW use a multidisciplinary team to manage women with IHD. Due to the paucity of randomized controlled trials investigating various manifestations of IHD, some treatments are not evidence-based such as those for coronary microvascular dysfunction and spontaneous coronary artery dissection. Sex-specific risk factors have been identified and multimodality cardiac imaging is improving in diagnosing IHD in women. Treatments are being studied to help improve symptoms and outcomes in women with IHD. There has been progress in the care of women with IHD. HCW can be instrumental in treating women with IHD, doing research, and being a source of research study participants.
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Affiliation(s)
- Abha Khandelwal
- Division of Cardiology, Women's Heart Health, Stanford University, Palo Alto, CA, USA
| | - May Bakir
- Division of Cardiology, Women's Heart Health Center, Loyola University, Chicago, IL, USA
| | - Meghan Bezaire
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Briana Costello
- Center for Women's Heart & Vascular Health, Texas Heart Institute, and Baylor St. Luke's Medical Center Hospital, Houston, TX, USA
| | | | - Valerie Hoover
- Department of Psychology, Stanford University, Palo Alto, CA, USA
| | - Noreen T Nazir
- Division of Cardiology, Department of Medicine, University of Illinois, Chicago, Chicago, USA
| | - Katherine Nichols
- Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Amy Reisenberg
- Stanford Healthcare, Stanford University, Palo Alto, CA, USA
| | - Anupama Rao
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Rupa Sanghani
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Melissa Tracy
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Annabelle Santos Volgman
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA. .,, Chicago, USA.
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108
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Ramcharitar R, Sharma AM. Look beyond the Heart: Extracoronary Vascular Manifestations of Spontaneous Coronary Artery Dissection. AJNR Am J Neuroradiol 2021; 42:1503-1504. [PMID: 34167957 DOI: 10.3174/ajnr.a7212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- R Ramcharitar
- Division of Cardiovascular MedicineUniversity of VirginiaCharlottesville, Virginia
| | - A M Sharma
- Division of Cardiovascular MedicineUniversity of VirginiaCharlottesville, Virginia
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109
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Masson W, Lobo M, Barbagelata L, Lavalle-Cobo A, Molinero G. Prognostic value of statin therapy in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): a meta-analysis. Acta Cardiol 2021; 77:480-487. [PMID: 34308792 DOI: 10.1080/00015385.2021.1955480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Given the complex aetiology and a limited amount of evidence, the medical treatment (including statin use) of myocardial infarction with non-obstructive coronary artery disease (MINOCA) remains uncertain. The objective of the present study was to evaluate the effect of statin therapy on major cardiovascular events (MACE) and mortality in MINOCA patients. METHODS A systematic review and meta-analysis of time-to-event outcomes were performed of studies of statin therapy on MINOCA patients, reporting data from MACE or mortality, after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases. A fixed-effects meta-analysis model was then applied. RESULTS Six observational studies of statin therapy on MINOCA, involving a total of 11,171 patients, were identified and considered eligible for analysis (9129 subjects received statin therapy while 2042 patients were part of the respective control arms). Quantitative analysis (5 studies were included) showed that statin use was associated with lower mortality (HR: 0.65; 95% CI: 0.56-0.75, I2: 0%). Also, the meta-analysis showed that statin therapy was associated with a lower incidence of MACE (HR: 0.78; 95% CI: 0.69-0.88, I2:27%). CONCLUSION Our data suggest that in a population with MINOCA, the use of statin therapy results in significant reduction on MACE and mortality. These results must be confirmed in future clinical trials.
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Affiliation(s)
- Walter Masson
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Buenos Aires, Argentina
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martín Lobo
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Buenos Aires, Argentina
- Cardiology Department, Hospital Militar Campo de Mayo, Buenos Aires, Argentina
| | - Leandro Barbagelata
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Buenos Aires, Argentina
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Augusto Lavalle-Cobo
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Buenos Aires, Argentina
- Cardiology Department, Sanatorio Finochietto, Buenos Aires, Argentina
| | - Graciela Molinero
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Buenos Aires, Argentina
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110
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Ravipati H, Rodrigues S, Rao S, Hatharaliyadda B, Junia C. The Young Heart Tears Easily Apart: A Case Report of Spontaneous Coronary Artery Dissection. Cureus 2021; 13:e15590. [PMID: 34277211 PMCID: PMC8272916 DOI: 10.7759/cureus.15590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 12/31/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), seen mostly in young females. The rarity and limited knowledge of the disease make its management challenging. Prompt diagnosis of the condition is extremely important to decrease both long- and short-term complications. Treatment options depend on hemodynamic stability and the location of the dissection- with more distal lesions treated more conservatively as opposed to proximal lesions which are treated with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The following are the two cases with different presentation, management and outcomes. Our first patient was a 35-year-old woman with no medical history who presented with acute, anginal pain, diaphoresis and palpitations. She was hemodynamically stable on presentation, with work-up significant for electrocardiogram (ECG) with sinus bradycardia, ST elevation in leads V1-V6, and elevated troponin level of 4 ng/ml. There was no evidence of a pulmonary embolism on computed tomography (CT) of the chest. A coronary angiogram showed 100% dissection of the proximal to mid-left anterior descending (LAD) artery. Attempts to place a stent in the proximal to mid LAD were unsuccessful as the true lumen of the LAD was not accessible. The patient became hemodynamically unstable, and an emergent CABG was done, restoring blood flow. The patient recovered during her hospital stay and was discharged with dual antiplatelet therapy (DAPT), beta-blockers, and atorvastatin. The second patient was a 28-year-old woman, with a history of hypertension who presented with anginal chest pain. Workup showed ECG with minimal ST elevations in anteroseptal leads, with elevated troponin level to 0.71 ng/ml. Coronary angiogram showed 40-50% stenosis of the mid LAD with an aneurysmal segment. An echocardiogram showed no evidence of wall motion abnormalities, and she had a normal left ventricular ejection fraction (LVEF). She was discharged home the next day, on medical management. After two days, she returned to the hospital with similar complaints, with work-up significant for ECG with non-specific ST-T abnormality, and troponin level which peaked at 2.22 ng/ml. She was started on a heparin drip, and a repeat left heart catheterization revealed type 2 dissection of the mid to distal LAD, with intravascular ultrasound showing a fractional flow reserve of 0.76. She was discharged home on DAPT, beta-blocker, calcium channel blocker (CCB), and atorvastatin, with close cardiology follow up. These two cases highlight the importance of keeping in mind the possibility of SCAD, especially when relatively healthy young women present with anginal symptoms. Early diagnosis of the condition and prompt management are extremely important to ensure favourable outcomes. The two cases also describe the coronary angiogram findings in SCAD, and the different strategies employed in the management of this condition.
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Affiliation(s)
| | | | - Swathi Rao
- Internal Medicine, MacNeal Hospital, Berwyn, USA
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111
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Preliminary Support for Group Cognitive Behavioral Therapy (CBT) to Reduce Psychological Distress in Patients with Spontaneous Coronary Artery Dissection (SCAD). J Clin Psychol Med Settings 2021; 28:826-832. [PMID: 34241761 PMCID: PMC8268614 DOI: 10.1007/s10880-021-09803-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 10/29/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) can occur as an atypical cause of myocardial infarction. Preliminary evidence suggests that SCAD patients experience high rates of post-event psychological distress. It is unknown whether psychosocial interventions may reduce the distress burden. Seven SCAD patients (mean age = 53.3 years) completed a CBT-based support group. All seven participants completed measures for anxiety, depression, and cardiac-related quality of life at baseline and post-intervention, and five participants completed measures at 3-month follow-up. Six of 7 participants scored above the clinical threshold on a measure of anxiety at baseline and posttreatment. At follow-up, 3 of 5 participants scored below the clinical threshold. For depression, 3 of 7 reported elevated depressive symptoms at baseline. By follow-up, 1 of 5 endorsed elevated depressive symptoms. This is the first known psychosocial intervention study of patients with SCAD. Anxiety symptoms improved for most patients by follow-up with some patients having improved depressive symptoms. Although the sample size is limited, this pilot study suggests a potential benefit of group psychosocial interventions for SCAD survivors.
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112
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Krittanawong C, Nazir S, Hassan Virk H, Hahn J, Wang Z, Fogg SE, Sharma SK, Alam M, Jneid H. Long-Term Outcomes Comparing Medical Therapy versus Revascularization for Spontaneous Coronary Artery Dissection. Am J Med 2021; 134:e403-e408. [PMID: 33773972 DOI: 10.1016/j.amjmed.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
The ideal management of spontaneous coronary artery dissection (SCAD) has yet to be clearly defined. We conducted a comprehensive search of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception from 1966 through September 2020 for all original studies (randomized controlled trials and observational studies) that evaluated patients with SCAD. Study groups were defined by allocation to medical therapy (medical therapy) versus invasive therapy (invasive therapy) (ie, percutaneous coronary intervention or coronary artery bypass grafting). The risk of death (risk ratio [RR] = 0.753; 95% confidence interval [CI]: 0.21-2.73; I2 = 21.1%; P = 0.61), recurrence of SCAD (RR = 1.09; 95% CI: 0.61-1.93; I2 = 0.0%; P = 0.74), and repeat revascularization (RR = 0.64; 95% CI: 0.21-1.94; I2 = 57.6%; P = 0.38) were not statistically different between medical therapy and invasive therapy for a follow-up ranging from 4 months to 3 years. In conclusion, in this meta-analysis of observational studies, the long-term risk of death, recurrent SCAD, and repeat revascularization did not significantly differ among patients with SCAD treated with medical therapy compared with those treated with invasive therapy. These findings support the current expert consensus that patients should be treated with medical therapy when clinically stable and no high-risk features are present. Further large-scale studies including randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- Chayakrit Krittanawong
- Michael E. DeBakey VA Medical Center, Houston, Tex; Section of Cardiology, Baylor School of Medicine, Houston, Tex.
| | - Salik Nazir
- Department of Cardiology, University of Toledo, Toledo, Ohio
| | - Hafeez Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Joshua Hahn
- Michael E. DeBakey VA Medical Center, Houston, Tex; Section of Cardiology, Baylor School of Medicine, Houston, Tex
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | | | - Samin K Sharma
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, NY
| | - Mahboob Alam
- Section of Cardiology, Baylor School of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | - Hani Jneid
- Michael E. DeBakey VA Medical Center, Houston, Tex; Section of Cardiology, Baylor School of Medicine, Houston, Tex
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113
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Tarantini G, Fabris T, Rodinò G, Fraccaro C. Improvement of symptoms and coronary perfusion gradient with mechanical left ventricular unloading in flow-limiting complex spontaneous coronary artery dissection, without revascularization. Catheter Cardiovasc Interv 2021; 98:E581-E585. [PMID: 34128584 PMCID: PMC8518797 DOI: 10.1002/ccd.29836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/20/2021] [Accepted: 06/05/2021] [Indexed: 11/12/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) can lead to acute coronary syndrome and sudden cardiac death, particularly in young women. Observational data show that, in SCAD patients, both percutaneous coronary intervention and coronary artery bypass grafting seem to be hampered by higher technical complexity, lower success rates, and worse outcomes. As spontaneous healing is a common occurrence, expert consensus advices medical management of the acute phase, when feasible. We present the case of a young woman with SCAD of left anterior descending artery causing myocardial infarction with ST-segment elevation. High-anatomical complexity and unstable conditions of the patient made both medical management and immediate revascularization unfeasible options. Therefore, we decided to implant a percutaneous off-loading mechanical support device to improve coronary perfusion pressure by unloading the left ventricle and preserve cardiac function, preventing worse complications of acute myocardial infarction. This strategy was successful in stabilizing the patient, until the definitive revascularization treatment became an option.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giulio Rodinò
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Kim ESH, Saw J, Kadian-Dodov D, Wood M, Ganesh SK. FMD and SCAD: Sex-Biased Arterial Diseases With Clinical and Genetic Pleiotropy. Circ Res 2021; 128:1958-1972. [PMID: 34110898 DOI: 10.1161/circresaha.121.318300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Multifocal fibromuscular dysplasia (FMD) and spontaneous coronary artery dissection are both sex-biased diseases disproportionately affecting women over men in a 9:1 ratio. Traditionally known in the context of renovascular hypertension, recent advances in knowledge about FMD have demonstrated that FMD is a systemic arteriopathy presenting as arterial stenosis, aneurysm, and dissection in virtually any arterial bed. FMD is also characterized by major cardiovascular presentations including hypertension, stroke, and myocardial infarction. Similar to FMD, spontaneous coronary artery dissection is associated with a high prevalence of extracoronary vascular abnormalities, including FMD, aneurysm, and extracoronary dissection, and recent studies have also found genetic associations between the two diseases. This review will summarize the relationship between FMD and spontaneous coronary artery dissection with a focus on common clinical associations, histopathologic mechanisms, genetic susceptibilities, and the biology of these diseases. The current status of disease models and critical future research directions will also be addressed.
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Affiliation(s)
- Esther S H Kim
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (E.S.H.K.)
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia Canada (J.S.)
| | - Daniella Kadian-Dodov
- Zena and Michael A. Wiener Cardiovascular Institute, Marie-Joseé and Henry R. Kravis Center for Cardiovascular Health, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (D.K.-D.)
| | - Malissa Wood
- Division of Cardiology, Harvard Medical School, Massachusetts General Hospital, Boston (M.W.)
| | - Santhi K Ganesh
- Division of Cardiovascular Medicine, Department of Internal Medicine (S.K.G.), University of Michigan Medical School, Ann Arbor.,Department of Human Genetics (S.K.G.), University of Michigan Medical School, Ann Arbor
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Erküner Ö, Ahmed W, Eerens F. Spontaneous dissection of a left internal mammary artery bypass graft: images in cardiology. Eur Heart J Case Rep 2021; 5:ytab232. [PMID: 34263127 PMCID: PMC8276319 DOI: 10.1093/ehjcr/ytab232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/12/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ömer Erküner
- Department of Cardiology, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
| | - Wehab Ahmed
- Department of Cardiology, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
| | - Filip Eerens
- Department of Cardiology, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
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Prudhvi K, Jonnadula J, Rokkam VRP, Kutti Sridharan G. Pregnancy associated spontaneous coronary artery dissection: A case report and review of literature. World J Cardiol 2021; 13:103-110. [PMID: 33968309 PMCID: PMC8069519 DOI: 10.4330/wjc.v13.i4.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/01/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pregnancy-associated spontaneous coronary artery dissection (PSCAD) is an important cause of chest pain and acute myocardial infarction in pregnant and postpartum women. Pregnancy is considered an isolated risk factor for spontaneous coronary artery dissection. The etiology, pathogenesis, and incidence of PSCAD are not known.
CASE SUMMARY We present a case of a 33-year-old postpartum female who presented with sudden onset chest pain and was diagnosed with spontaneous coronary artery dissection and needed urgent catheterization revealing left anterior descending coronary artery dissection. She underwent emergent coronary artery bypass graft surgery with good post-operative recovery.
CONCLUSION Most patients with PSCAD can be managed conservatively with medical management and have good outcomes. Patients with high-risk presentations benefit from the invasive approach. Coronary artery bypass graft may be required in select few patients based on angiography findings. Due to the risk of recurrent spontaneous coronary artery dissection, subsequent pregnancies are discouraged.
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Affiliation(s)
- Kalyan Prudhvi
- Division of Critical Care Medicine, Mercy Hospital, Saint Louis University School of Medicine, St. Louis, MO 63141, United States
| | - Jayasree Jonnadula
- Department of Geriatric Medicine, Barnes Jewish Hospital/Washington University, St. Louis, MO 63110, United States
| | - Venkata Ram Pradeep Rokkam
- Division of Inpatient Medicine, University of Arizona/Banner University Medical Center, Tucson, AZ 85719, United States
| | - Gurusaravanan Kutti Sridharan
- Division of Inpatient Medicine, University of Arizona/Banner University Medical Center, Tucson, AZ 85719, United States
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Sehgal R, O'Cochlain DF, Virata AR, Singh G. Disseminated Blastomycosis Presenting with Spontaneous Coronary Artery Dissection. Eur J Case Rep Intern Med 2021; 8:002511. [PMID: 33987130 DOI: 10.12890/2021_002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 01/09/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of acute coronary syndrome (ACS) and myocardial infarction (MI) in individuals with few or no known atherosclerotic risk factors. While systemic autoimmune inflammatory disorders are associated with precipitating SCAD, the role of infection-induced systemic inflammation in SCAD is not well defined. We present the case of a 49-year-old Caucasian woman with ST-elevation myocardial infarction (STEMI) diagnosed as SCAD from a severe systemic inflammatory response related to disseminated blastomycosis. Punch biopsy of a skin lesion and synovial fluid culture confirmed Blastomyces dermatitidis. This case suggests the possibility of systemic infection-induced inflammation as a precipitating factor in SCAD pathogenesis similar to autoimmune inflammatory disorders. LEARNING POINTS Recognize the role of systemic inflammation from severe infection as a possible cause of spontaneous coronary artery dissection (SCAD).Recognize that cardiac involvement is rare in blastomycosis.Coronary revascularization may be required in SCAD for haemodynamic instability, ischaemic chest pain progression, and myocardium at risk.
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Affiliation(s)
- Rahul Sehgal
- Department of Rheumatology, Mayo Clinic Alix School of Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - D Fearghas O'Cochlain
- Department of Cardiovascular Medicine, Mayo Clinic Alix School of Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Andrew R Virata
- Department of Pathology, Mayo Clinic Alix School of Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Gurpreet Singh
- Department of Cardiovascular Medicine, Mayo Clinic Alix School of Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
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