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Hosseini K, Fallahtafti P, Roudbari P, Soleimani H, Jahromi NA, Jameie M, Jenab Y, Moradi A, Ajam A, Heydari N, Kuno T, Narula N, Kampaktsis PN. Spontaneous coronary artery dissection in patients with prior psychophysical stress: a systematic review of case reports and case series. BMC Cardiovasc Disord 2024; 24:235. [PMID: 38702627 PMCID: PMC11067298 DOI: 10.1186/s12872-024-03902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome, particularly in younger women. Due to limited information about SCAD, case reports and case series can provide valuable insights into its features and management. This study aimed to comprehensively evaluate the features of SCAD patients who experienced psychophysical stress before the SCAD event. METHODS We conducted an electronic search of PubMed, Scopus, and Web of Science from inception until January 7, 2023. We included case reports or series that described patients with SCAD who had experienced psychophysical stress before SCAD. Patients with pregnancy-associated SCAD were excluded from our analysis. RESULTS In total, we included 93 case reports or series describing 105 patients with SCAD. The average patient age was 44.29 ± 13.05 years and a total of 44 (41.9%) of patients were male. Among the included SCAD patients the most prevalent comorbidities were fibromuscular dysplasia (FMD) and hypertension with the prevalence of 36.4 and 21.9%, respectively. Preceding physical stress was more frequently reported in men than in women; 38 out of 44 (86.4%) men reported physical stress, while 36 out of 61 (59.1%) females reported physical stress (p value = 0.009). On the other hand, the opposite was true for emotional stress (men: 6 (13.6%)), women: 29 (47.6%), p value < 0.001). Coronary angiography was the main diagnostic tool. The most frequently involved artery was the left anterior descending (LAD) (62.9%). In our study, recurrence of SCAD due to either the progression of a previous lesion or new SCAD in another coronary location occurred more frequently in those treated conservatively, however the observed difference was not statistically significant (p value = 0.138). CONCLUSION While physical stress seems to precede SCAD in most cases, emotional stress is implicated in females more than males.
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Affiliation(s)
- Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Parisa Fallahtafti
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Roudbari
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Soleimani
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran.
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran.
- Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, 1411713139, Iran.
| | - Negin Abiri Jahromi
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Mana Jameie
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Yaser Jenab
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Ali Moradi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ajam
- Department of Medicine and Vascular Medicine Institute, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, USA
| | - Narges Heydari
- Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Toshiki Kuno
- Department of Medicine, Montefiore Medical Center, New York, NY, 10461, USA
| | - Nupoor Narula
- Weill Cornell Medicine, New York Presbyterian, New York City, USA
| | - Polydoros N Kampaktsis
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, 10032, USA
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Bloom CA, Eichelberger GS, Hackney NA, Chang PD. Spontaneous Coronary Artery Dissection in a 19-Year-Old Male Athlete. JACC Case Rep 2024; 29:102189. [PMID: 38361558 PMCID: PMC10865123 DOI: 10.1016/j.jaccas.2023.102189] [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: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 02/17/2024]
Abstract
We present a 19-year-old male athlete, without cardiovascular risk factors, with anterior ST-segment elevation myocardial infarction caused by left anterior descending artery spontaneous coronary artery dissection. Symptoms began during a swim practice, and patient endorsed using C4 Ripped (Cellucor), a preworkout supplement to enhance athletic performance. We hypothesize that this was the major contributor to presentation. The patient showed improvement after 4 days.
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Affiliation(s)
- Charissa A. Bloom
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Gerry S. Eichelberger
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Noah A. Hackney
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Patrick D. Chang
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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3
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Eshraghi A, Jalalyazdi M, Ramezani J, Baburian M. Late presentation of iatrogenic dissection of right coronary cusp: A case report. J Cardiovasc Thorac Res 2021; 12:341-344. [PMID: 33510886 PMCID: PMC7828762 DOI: 10.34172/jcvtr.2020.55] [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] [Received: 05/13/2019] [Accepted: 04/08/2020] [Indexed: 01/27/2023] Open
Abstract
Iatrogenic dissection of coronary arteries while performing catheter engagement, in general is not uncommon. However, we encountered a relatively rare case of iatrogenic right coronary cusp dissection.Here we report an iatrogenic coronary artery dissection after diagnostic angiography in a 54-year-oldwoman presented with exertional dyspnea and chest discomfort. In our case delayed progression of sub-intimal hematoma and subsequent compression of RCA ostium an SA node branch was the cause of SA node dysfunction and subsequent junctional rhythm and atrial fibrillation.
To conclude it should be said that in catastrophic cases of iatrogenic coronary ostia dissection and ensuing aortic cusp involvement, stenting of entry point at coronary ostia is a logical decision with good result.
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Affiliation(s)
- Ali Eshraghi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Jalalyazdi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Ramezani
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Baburian
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Spontaneous Coronary Artery Dissection: Report of 3 Cases and Literature Review Hormonal, Autoimmune, Morphological Factors. Am J Forensic Med Pathol 2016; 36:188-92. [PMID: 26010056 DOI: 10.1097/paf.0000000000000167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The number of cases with spontaneous coronary artery dissection (SCAD) is considered to be being underestimated because of a large amount of SCAD leading to sudden death without previous diagnosis. Besides, not only in clinics but also in autopsy practice, correct diagnosis of SCAD is important to prevent forensic malpractice.The article is intended to discuss the pathological findings through the forensic point of view for improving the malpractice expertise in scope of clinicians' timely antemortem diagnosis according to risk factors and in scope of forensic pathologists' the cause of death determination ability according to macroscopical and microscopical findings of the autopsy.In 3 cases reported, the main characteristics were the female sex, pregnancy history and a sudden death without any trauma. However, although there are many women giving birth or using oral contraceptives, only some of them are facing with SCAD. This suggests the possibility of some hereditary factors, whereas hereditary characteristics may be understood in many different ways like hormone-releasing regulating mechanisms as well as immunity, morphology, or any other mechanism. For instance, autoimmunity has been also a hereditary underlying factor for vessel injury considered in presented cases.
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5
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Lettieri C, Zavalloni D, Rossini R, Morici N, Ettori F, Leonzi O, Latib A, Ferlini M, Trabattoni D, Colombo P, Galli M, Tarantini G, Napodano M, Piccaluga E, Passamonti E, Sganzerla P, Ielasi A, Coccato M, Martinoni A, Musumeci G, Zanini R, Castiglioni B. Management and Long-Term Prognosis of Spontaneous Coronary Artery Dissection. Am J Cardiol 2015; 116:66-73. [PMID: 25937347 DOI: 10.1016/j.amjcard.2015.03.039] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 12/15/2022]
Abstract
The optimal management and short- and long-term prognoses of spontaneous coronary artery dissection (SCAD) remain not well defined. The aim of this observational multicenter study was to assess long-term clinical outcomes in patients with SCAD. In-hospital and long-term outcomes were assessed in 134 patients with documented SCAD, as well as the clinical impact and predictors of a conservative rather than a revascularization strategy of treatment. The mean age was 52 ± 11, years and 81% of patients were female. SCAD presented as an acute coronary syndromes in 93% of patients. A conservative strategy was performed in 58% of patients and revascularization in 42%. On multivariate analysis, distal versus proximal or mid location of dissection (odds ratio 9.27) and basal Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 or 3 versus 0 or 1 (odds ratio 0.20) were independent predictors of conservative versus revascularization strategy. A conservative strategy was associated with better in-hospital outcomes compared with revascularization (rates of major adverse cardiac events 3.8% and 16.1%, respectively, p = 0.028); however, no significant differences were observed in the long-term outcomes. In conclusion, in this large observational study of patients with SCAD, angiographic features significantly influenced the treatment strategy, providing an excellent short- and long-term prognosis.
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Affiliation(s)
| | - Dennis Zavalloni
- Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy
| | - Roberta Rossini
- Department of Cardiology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Nuccia Morici
- Department of Cardiology, Ospedale Niguarda, Milano, Italy
| | | | - Ornella Leonzi
- Department of Cardiology, Ospedale Poliambulanza, Brescia, Italy
| | - Azeem Latib
- Department of Cardiology, Istituto Scientifico San Raffaele, Milano, Italy
| | - Marco Ferlini
- Department of Cardiology, Policlinico S. Matteo, Pavia, Italy
| | | | - Paola Colombo
- Department of Cardiology, Ospedale Niguarda, Milano, Italy
| | - Mario Galli
- Department of Cardiology, Ospedale S. Anna, Como, Italy
| | | | | | | | | | - Paolo Sganzerla
- Department of Cardiology, Ospedale di Treviglio Caravaggio, Treviglio, Italy
| | - Alfonso Ielasi
- Department of Cardiology, Ospedale Mater Domini, Castellanza Italy
| | - Micol Coccato
- Department of Cardiology, Università di Padova, Padova, Italy
| | | | - Giuseppe Musumeci
- Department of Cardiology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Roberto Zanini
- Department of Cardiology, Ospedale Carlo Poma, Mantova, Italy
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D'Ovidio C, Sablone S, Carnevale A. Spontaneous coronary artery dissection: case report and literature review. J Forensic Sci 2015; 60:801-6. [PMID: 25678077 DOI: 10.1111/1556-4029.12722] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/26/2014] [Accepted: 05/22/2014] [Indexed: 11/28/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction and sudden cardiac death. It occurs most commonly in otherwise healthy women during pregnancy or the postpartum period. The true incidence of SCAD is underestimated, as most cases are diagnosed at autopsy. The pathophysiology of SCAD is still not fully understood, and its management can be challenging. This report describes a 35-year-old pregnant female who presented with an acute antero-lateral ST elevation secondary to spontaneous dissection of the left anterior descending artery and the circumflex artery. The diagnosis was established by coronary artery angiography. However, the patient died following cardiac tamponade. The examination of this case represented a starting point for the reviewing of the diagnosis, clinical course, and management of SCAD, and for the placing of this in context with the existing literature. This study highlights the importance of prompt diagnosis and subsequent lifesaving treatment.
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Affiliation(s)
- Cristian D'Ovidio
- Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Via dei Vestini, 31, 66100, Chieti, Italy
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7
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Wilson RF. Coronary Angiography. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Markham R, Rahman A, Tai S, Hamilton-Craig I, Hamilton-Craig C. Myocardial infarction from isolated coronary artery vasculitis in a young patient: a rare case. Int J Cardiol 2014; 180:40-1. [PMID: 25438205 DOI: 10.1016/j.ijcard.2014.11.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 11/23/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Ryan Markham
- University of Queensland, Brisbane, Australia; Gold Coast University Hospital, Gold Coast, Australia.
| | - Atifur Rahman
- Gold Coast University Hospital, Gold Coast, Australia; Griffith University, Gold Coast, Australia
| | - Shayan Tai
- Griffith University, Gold Coast, Australia
| | - Ian Hamilton-Craig
- Gold Coast University Hospital, Gold Coast, Australia; Griffith University, Gold Coast, Australia
| | - Christian Hamilton-Craig
- University of Queensland, Brisbane, Australia; Heart and Lung Institute, The Prince Charles Hospital, Brisbane, Australia; University of Washington, Seattle, WA, United States
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9
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Spontaneous coronary artery dissection. Int J Cardiol 2014; 175:8-20. [DOI: 10.1016/j.ijcard.2014.04.178] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 02/19/2014] [Accepted: 04/17/2014] [Indexed: 02/03/2023]
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10
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Spontaneous coronary artery dissection diagnosed by multislice computed tomography. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 9:111-3. [PMID: 24570701 PMCID: PMC3915952 DOI: 10.5114/pwki.2013.34038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 12/30/2012] [Accepted: 01/14/2013] [Indexed: 11/22/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Spontaneous coronary artery dissection can cause stable angina pectoris, unstable angina pectoris, acute myocardial infarction, cardiogenic shock and sudden cardiac death. It usually occurs in young to middle aged women. Atherosclerosis, peripartum period, and structural and inflammatory diseases affecting the artery wall are predisposing factors. It shows similar clinical presentation to coronary artery disease. Diagnosis and early treatment decrease mortality. Treatment options are medical treatment, percutaneous coronary intervention and surgery. The treatment decision is made according to the clinical presentation of the patient, the affected coronary artery and the length of the dissected segment. Diagnosis of the disease is usually made by coronary angiography. We present a patient who consulted our clinic with atypical chest pain and was diagnosed with spontaneous left anterior descending dissection by coronary computed tomography angiography.
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11
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Bartolomucci F, Cipriani F, Valente G, Curci S, Deluca G. Un’insolita astenia: un caso di cardiomiopatia dilatativa in un giovane con dissezione coronarica spontanea. ITALIAN JOURNAL OF MEDICINE 2012. [DOI: 10.1016/j.itjm.2011.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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12
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Farsak B, Oc M, Oc B, Simsek M, Akbayrak H, Avcı A. Spontaneous Coronary Artery Dissections: Three Case Reports and Review of Literature. Heart Surg Forum 2012; 15:E232-5. [DOI: 10.1532/hsf98.20121055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction and is mostly fatal. Previous studies report that it is mostly seen in middle-aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern, and its severity is related to extent and development rate of dissection. Herein we present three cases of primary spontaneous left main coronary artery dissection. Two of the patients are men and the third patient is a non-pregnant 69-year-old woman. The cases were presented and discussed with review of the pertinent literature.
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13
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Truesdell AG, Delgado GA, Li J, Abbott JD, Atalay MK, Singh AK. Challenges in the management of postpartum spontaneous coronary artery dissection. Interv Cardiol 2012. [DOI: 10.2217/ica.12.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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El-Sherief K, Rashidian A, Srikanth S. Spontaneous coronary artery dissection after intense weightlifting UCSF Fresno Department of Cardiology. Catheter Cardiovasc Interv 2011; 78:223-7. [PMID: 21413128 DOI: 10.1002/ccd.22904] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 10/29/2010] [Indexed: 11/09/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of chest pain and cardiomyopathy. This phenomenon usually occurs during the peripartum period. SCAD associated with exercise and heavy weight lifting is even rarer and has been reported in less than 10 cases in the literature. We describe a case of SCAD associated with heavy weight lifting and exercise in a 29-year-old male who presented with exertional chest pain. The patient subsequently underwent a cardiac catheterization that showed a left ventricular ejection fraction of 40% and a dissection in the left anterior descending (LAD) coronary artery after the first diagonal/septal branch with extension to the distal LAD that wrapped around the apex. He was effectively managed with the combination of medical therapy followed by a few days later with stenting. In summary, diagnosis and treatment of this rare phenomenon is a challenge, but early diagnosis and appropriate management can lead to a successful outcome.
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Affiliation(s)
- Karim El-Sherief
- Division of Cardiology, Department of Medicine, UCSF Fresno, Fresno, California 93701, USA.
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Marti V, Garcia-Picart J, Balcells J. Coronary stenting after failure of conservative treatment for spontaneous coronary dissection: Usefulness of the intravascular ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:175-178. [PMID: 21321943 DOI: 10.1002/jcu.20796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 12/20/2010] [Indexed: 05/30/2023]
Abstract
Spontaneous coronary dissection of a coronary artery is a rare cause of acute coronary syndrome. Optimal treatment has not yet been established. We describe a woman with spontaneous dissection of the left anterior descending artery who presented transitory angina and electrocardiographic ST segment elevation in precordial leads. Conservative treatment was carried out. The angina and electrocardiographic changes recurred 3 days later. An intravascular vascular ultrasound was performed and the patient was stabilized following stenting. Stress testing was negative at 6-month follow-up and she remained asymptomatic at 18 months. We discuss the usefulness of an intravascular ultrasound study to establish the therapeutic strategy.
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Affiliation(s)
- Vicens Marti
- Department of Cardiology and Cardiac Surgery, Hospital de Sant Pau, Barcelona, Spain.
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16
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Sabatine MS, Jaffer FA, Staats PN, Stone JR. Case records of the Massachusetts General Hospital. Case 28-2010. A 32-year-old woman, 3 weeks post partum, with substernal chest pain. N Engl J Med 2010; 363:1164-73. [PMID: 20843252 DOI: 10.1056/nejmcpc1000966] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marc S Sabatine
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, and Department of Medicine, Harvard Medical School, Boston, USA
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Ohara Y, Kusunose M, Take Y, Sahara S, Banba K, Nishimoto M, Yamamoto K. Successful treatment in a case of acute myocardial infarction due to spontaneous coronary artery dissection. J Cardiol Cases 2010; 1:e102-e105. [DOI: 10.1016/j.jccase.2009.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 09/24/2009] [Accepted: 09/28/2009] [Indexed: 11/26/2022] Open
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Celik T, Iyisoy A, Cingoz F. A case of spontaneous coronary artery dissection who had high titer of anticardiolipin antibody (IgM) treated by emergent surgery. J Cardiol 2010; 55:151-3. [PMID: 20122565 DOI: 10.1016/j.jjcc.2009.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
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Monte I, Grasso S, Scandura S, Mangiafico S, Tamburino C. Spontaneous coronary artery dissection: a report of two atypical cases. Heart Vessels 2009; 24:380-4. [PMID: 19784823 DOI: 10.1007/s00380-008-1139-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Accepted: 12/19/2008] [Indexed: 11/25/2022]
Abstract
Spontaneous coronary artery dissection is a rare pathology that has no exact incidence, etiology, pathogenesis and evolution in literature. We report two cases of two women with coronary artery dissection, uncommon clinical presentation of acute coronary syndrome and without identifiable risk factors. A review of the literature and the management of this condition are presented.
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Affiliation(s)
- Ines Monte
- Clinical Echocardiography, EchoDiagnostic Department, Polyclinic of University of Catania, Catania, Italy.
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Shankarappa RK, Panneerselvam A, Dwarakaprasad R, Karur S, Krishnanaik GB, Nanjappa MC. Spontaneous asymptomatic coronary artery dissection in a young man. J Cardiol 2009; 54:499-502. [PMID: 19944330 DOI: 10.1016/j.jjcc.2009.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 03/16/2009] [Accepted: 03/18/2009] [Indexed: 11/29/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare condition that most often presents as acute coronary syndrome or sudden cardiac death. Here we present the case of a young man of 25 years, who had remained asymptomatic in spite of SCAD. This case highlights the fact that spontaneous dissections can occur at a young age and can involve more than one coronary artery, without producing clinical symptoms.
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21
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A Double-wire Technique for Dealing with Catheter-induced Right Coronary Artery Dissection Extending to the Aortic Root. Tzu Chi Med J 2008. [DOI: 10.1016/s1016-3190(08)60059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Kang WC, Oh KJ, Han SH, Ahn TH, Shin EK. Progression of dissection due to residual dissection after intracoronary stenting for spontaneous coronary dissection at bifurcation site of LAD and diagonal artery. Int J Cardiol 2008; 125:e40-3. [PMID: 17397947 DOI: 10.1016/j.ijcard.2006.12.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 12/30/2006] [Indexed: 11/28/2022]
Abstract
A 34-year old male patient visited our hospital due to severe chest pain. Initial ECG showed ST elevation at precordial leads and all cardiac enzymes were markedly elevated. Coronary angiography showed a long, longitudinal coronary dissection with dissected flap extending from the proximal LAD to the mid segment of the vessel and proximal diagonal artery. IVUS showed dissected flap and false lumen communicating with true lumen from proximal to mid-LAD. We implanted two paclitaxel-eluting stents using crushing technique at bifurcation lesion and overlapped another paclitaxel-eluting stent at proximal LAD for full coverage of dissection. Final angiography showed good distal flow. However, despite of maximal pressure of post stent ballooning, a residual dissection was noted at proximal LAD. IVUS examination also showed encircling gap that was noted between stent and vessel wall at proximal LAD stent area. Because distal flow was good and there was no ischemic symptom and sign, the patient was discharged. Six months later from index procedure, routine follow-up angiography and IVUS examination were performed and revealed more progressed previous residual coronary dissection at proximal LAD which was extended to bifurcation site. Our case showed, although intracoronary stenting might be an attractive approach by closure of the inlet and the false lumen, complete resolution of dissection by stenting is very important for long-term prognosis.
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Páez M, Buisán F, Herrero E. Spontaneous dissection of the left coronary artery trunk during the postpartum period treated with revascularization surgery, ventricular assistance and a successful heart transplant. Acta Anaesthesiol Scand 2007; 51:960-1. [PMID: 17635409 DOI: 10.1111/j.1399-6576.2007.01359.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Spontaneous coronary artery dissection is a rare cause of acute cardiac events and occurs most frequently in the peripartum period. Coronary artery dissection related to exercise is even more unusual, with only a few cases reported in the literature. We report a case of acute coronary artery dissection related to exercise in a 17-yr-old high school athlete, and we review the available literature on exercise-related coronary dissection. METHODS We performed a PubMed literature search using the search terms exercise, sports, spontaneous coronary dissection, and athletics. We found seven cases of spontaneous coronary artery dissection that had occurred during intense physical exercise. Vigorous exercise can provoke acute ischemic events, but such events occur primarily in adults with atherosclerotic disease. Many of the cases reported as spontaneous coronary artery dissection are more likely atherosclerotic plaque rupture, in which cases they are not truly spontaneous. Because spontaneous coronary dissection is so rare, there are no available recommendations on how to manage young athletes with this condition. We permitted this athlete to return to limited competition, without data to support either a total restriction or even a limited restriction, with the written understanding that a recurrent event is possible but probably unlikely. In summary, spontaneous coronary artery dissection should be considered in young individuals presenting with exercise-related acute ischemic cardiac events.
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Affiliation(s)
- Ravishankar V Kalaga
- Division of Cardiology, Henry Low Heart Center, Hartford Hospital, Hartford, CT 06102, USA
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25
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Gul I, Basar E, Cetinkaya Y, Kasapkara A, Kalay N, Ozdogru I. Spontaneous coronary artery dissection and pulmonary thromboembolism: a case report. Int J Cardiol 2007; 118:e21-3. [PMID: 17376551 DOI: 10.1016/j.ijcard.2006.11.250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 11/28/2006] [Accepted: 11/28/2006] [Indexed: 11/17/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) still is a rare cause of acute coronary syndrome. SCAD has been observed in three groups of patients: those with coronary atherosclerosis, peripartal women and idiopathic group. SCAD may be associated with some conditions. We report an unusual association: SCAD and pulmonary thromboembolism.
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26
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Wilson RF, White CW. Coronary Angiography. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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27
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Capuano C, Sesana M, Predolini S, Leonzi O, Cuccia C. Literature review: spontaneous coronary artery dissections. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2006; 7:231-3. [PMID: 17174869 DOI: 10.1016/j.carrev.2006.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 07/18/2006] [Accepted: 07/18/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Cinzia Capuano
- Catheterization Laboratory, Cardiology Department, Poliambulanza Hospital, 25124 Brescia, Italy.
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28
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Rogers IS, Rinaldi MJ, Humphrey CB, Boden WE, Dougherty JE. Postpartum dissection of the left main coronary artery. Clin Cardiol 2006; 29:175-8. [PMID: 16649728 PMCID: PMC6654591 DOI: 10.1002/clc.4960290410] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Peripartum coronary artery dissection is rare, but it is an increasingly recognized risk to women of childbearing age. Literature reviews reveal that about 80% of the population with spontaneous coronary artery dissections (SCAD) are female, and approximately 25-33% of cases occurred while the woman was pregnant or in the peripartum phase. Most cases have presented within 2 weeks of delivery. The left anterior descending is the most commonly affected vessel. The etiology is poorly understood, but many reports suggest that SCAD occurs as a result of protease release secondary to an eosinophilic vasculitis resulting in vessel lysis. Many investigators have examined the correlation between peripartum SCAD and estrogen levels; however, case studies have shown conflicting results regarding estrogen levels as the putative causative factor. Optimal treatment remains controversial. Presently, stenting appears to be best employed in the patients who have single-vessel dissection not involving the left main coronary artery (LMCA). Surgical revascularization via coronary artery bypass graft remains the optimal therapy in patients whose dissection involves the LMCA, in patients with concurrent multivessel dissection, and in patients with disease refractory to medical management. It is important to consider coronary artery dissection in the differential of any young woman who presents with signs or symptoms consistent with acute coronary syndrome, particularly if she is peripartum. Furthermore, once suspected, it is imperative that a definitive diagnostic study, that is, coronary angiography, be completed prior to the initiation of treatment whenever possible.
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Affiliation(s)
- Ian S. Rogers
- Department of Medicine, Boston University Medical Center, and Boston University School of Medicine, Boston, Massachusetts
| | - Michael J. Rinaldi
- Division of Cardiology, Department of Medicine, Hartford Hospital, Hartford
| | - Chester B. Humphrey
- Division of Cardiothoracic Surgery, Hartford Hospital, Hartford, and Department of Surgery, University of Connecticut School of Medicine, Farmington
| | - William E. Boden
- Division of Cardiology, Hartford Hospital, Hartford, and University of Connecticut School of Medicine, Farmington
| | - James E. Dougherty
- Division of Cardiology, Department of Medicine, Hartford Hospital, Hartford, and Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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29
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Abstract
Although myocardial infarction (MI) mainly occurs in patients older than 45, young men or women can suffer MI. Fortunately, its incidence is not common in patients younger than 45 years. However, the disease carries a significant morbidity, psychological effects, and financial constraints for the person and the family when it occurs at a young age. The causes of MI among patients aged less than 45 can be divided into four groups: (1) atheromatous coronary artery disease; (2) non-atheromatous coronary artery disease; (2) hyper-coagulable states; (4) MI related to substance misuse. There is a considerable overlap between all the groups. This article reviews the literature and highlights the practical issues involved in the management of young adults with MI.
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Affiliation(s)
- M Egred
- Cardiothoracic Centre, Liverpool L14 3PE, UK.
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30
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Brunetti ND, Pellegrino PL, Mavilio G, Cuculo A, Ziccardi L, Correale M, Di Biase M. Spontaneous coronary dissection complicating unstable coronary plaque in young women with acute coronary syndrome: case reports. Int J Cardiol 2006; 115:105-7. [PMID: 16753230 DOI: 10.1016/j.ijcard.2005.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 12/10/2005] [Indexed: 11/28/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) causing acute myocardial infarction is a rare event. It occurs mostly in young women without traditional risk factors for coronary artery disease, particularly during the peripartum period. We describe two occurrences of SCAD in young women in whom coronary atherosclerosis was also present. In both cases, angiography showed extended coronary dissection on the left anterior descending coronary artery (LAD), starting from an atheromasic stenosis on the middle LAD segment. Coronary dissection could complicate an unstable atheromasic plaque, especially in young women presenting with acute coronary syndrome.
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31
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Maeder M, Ammann P, Angehrn W, Rickli H. Idiopathic spontaneous coronary artery dissection: incidence, diagnosis and treatment. Int J Cardiol 2005; 101:363-9. [PMID: 15907402 DOI: 10.1016/j.ijcard.2004.03.045] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2003] [Revised: 01/09/2004] [Accepted: 03/03/2004] [Indexed: 01/01/2023]
Abstract
BACKGROUND Less is known about characteristics, treatment and follow-up of patients with spontaneous coronary artery dissection (SCAD) without associated pregnancy or underlying atherosclerosis. METHODS We reviewed 5054 consecutive coronary angiographies for SCAD in patients without atherosclerosis or associated pregnancy and performed follow-up angiography in eligible patients. RESULTS SCAD were assessed in five patients (mean age 44 +/- 8.7 years). Interestingly, all were premenopausal women. Three had no cardiovascular risk factors, whereas two were previous smokers and one had slightly elevated cholesterol levels. Clinical presentation was acute myocardial infarction in four cases and unstable angina pectoris in one of them. Dissection was localized in the left anterior descending artery (LAD) in three cases and in the first marginal branch of the left circumflex artery in two cases. Three patients were treated conservatively with antithrombotic therapy and beta-blocker, whereas in one patient rescue-PCI with stenting of the ostium of the LAD was performed after failed thrombolysis. The fifth woman with dissected proximal LAD underwent CABG. Follow-up angiographies after 5.9 +/- 4.4 months showed complete angiographic resolution of the dissection in the medically treated patients and a perfect angiographic result of the stented LAD. All patients were free of symptoms after a mean follow-up of 13 +/- 10 months. CONCLUSIONS Idiopathic SCAD is a rare cause of acute coronary syndrome in premenopausal women. In case of single vessel dissection and normal blood flow of the dissected vessel, medical treatment with aspirin, clopidogrel and beta-blockade leads to complete angiographic resolution within a few months.
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Affiliation(s)
- Micha Maeder
- Division of Cardiology, Department of Internal Medicine, Hospital of St. Gallen, Switzerland.
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32
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Almeda FQ, Barkatullah S, Kavinsky CJ. Spontaneous coronary artery dissection. Clin Cardiol 2004; 27:377-80. [PMID: 15298035 PMCID: PMC6654176 DOI: 10.1002/clc.4960270702] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2002] [Accepted: 04/02/2003] [Indexed: 11/12/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial ischemia with complex pathophysiology. This paper reviews the major diagnostic and therapeutic issues of this rare but important disease. The diagnosis of SCAD should be strongly considered in any patient who presents with symptoms suggestive of acute myocardial ischemia, particularly in young subjects without traditional risk factors for coronary artery disease (especially in young women during the peripartum period or in association with oral contraceptive use). Urgent coronary angiography is indicated to establish the diagnosis and to determine the appropriate therapeutic approach. The decision to pursue medical management, percutaneous coronary intervention, or surgical revascularization is based primarily on the clinical presentation, extent of dissection, and amount of ischemic myocardium at risk.
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Affiliation(s)
- Francis Q Almeda
- Rush Heart Institute, Rush University Medical Center and Rush Medical College, Chicago, Illinois, USA.
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33
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Verma PK, Sandhu MS, Mittal BR, Aggarwal N, Kumar A, Mayank M, Bhattacharya A, Anand RK, Grover A. Large spontaneous coronary artery dissections-a study of three cases, literature review, and possible therapeutic strategies. Angiology 2004; 55:309-18. [PMID: 15156265 DOI: 10.1177/000331970405500311] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Spontaneous coronary artery dissection is rare, but is now being increasingly recognized as a prominent cause of acute ischemic coronary events occurring usually in relatively young patients, predominantly females. The authors describe the clinical course of 3 patients (1 woman) in whom large spontaneous coronary artery dissections developed. All had diverse clinical presentations;1 presenting with heart failure, the second with post-myocardial infarction angina, and the third with syncope. The second patient underwent coronary angioplasty with multiple overlapping stents while in the other two, it was the considered opinion to continue aggressive medical therapy. The 1-year follow-up was uneventful in all 3 patients. The risk factors ascertained in our patients were diabetes mellitus, smoking, and hypertension.
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Affiliation(s)
- Puneet K Verma
- Departments of Cardiology and Nuclear Medicine, Institute of Medical Education and Research, Chandigarh, India.
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34
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Aqel RA, Zoghbi GJ, Iskandrian A. Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: a review. Echocardiography 2004; 21:175-82. [PMID: 14961799 DOI: 10.1111/j.0742-2822.2004.03050.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare cause of myocardial ischemia and sudden death. Coronary aneurysms and pseudoaneurysms, which may occur after percutaneous coronary interventions, rarely occur spontaneously. We review the pertinent medical literature and describe the intravascular findings of spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms.
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Affiliation(s)
- Raed A Aqel
- Birmingham's Veterans Affairs Medical Center, Division of Cardiovascular Disease, Alabama 35233, USA.
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35
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Wong EM, Pawsey C, Lowe HC. Evidence for "lumen sealing" with sirolimus eluting stents in the treatment of complex coronary artery dissection. Heart 2004; 90:e13. [PMID: 14966074 PMCID: PMC1768114 DOI: 10.1136/hrt.2003.026609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Immediate and two month angiographic and intravascular ultrasound examination of sirolimus eluting stents deployed for complex coronary dissection is presented. The findings support the hypothesis that this novel treatment option is both effective and safe.
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Affiliation(s)
- E M Wong
- Concord Repatriation General Hospital, Sydney, Australia
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36
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Aqel RA, Zoghbi GJ, Iskandrian AE. Spontaneous Coronary Artery Dissection with Pseudoaneurysm Formation Diagnosed by Intravascular Ultrasound: A Case Report. Echocardiography 2004; 21:153-7. [PMID: 14961795 DOI: 10.1111/j.0742-2822.2004.02160.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare cause of myocardial ischemia. Coronary artery pseudoaneurysm may occur after percutaneous coronary interventions and rarely spontaneously. We present a patient who had spontaneous coronary artery dissection with formation of a pseudoaneurysm diagnosed by intravascular ultrasound.
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Affiliation(s)
- Raed A Aqel
- Division of Cardiovascular Disease, Birmingham's Veterans Affairs Medical Center Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
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37
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Berenguer A, Mainar V, Bordes P, Valencia J, Arrarte V. [Spontaneous coronary artery dissection. An infrequent cause of acute coronary syndromes]. Rev Esp Cardiol 2004; 56:1017-21. [PMID: 14563298 DOI: 10.1016/s0300-8932(03)77001-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Spontaneous coronary artery dissection is a rare condition that may produce severe myocardial ischemia. The growth of indications for cardiac catheterization have led to an increment in the number of cases identified in patients with acute coronary syndromes. Because the therapeutic approach and prognosis are uncertain, doubts often arise regarding the optimal management of these patients. We describe here the clinical and angiographic characteristics of 7 patients with spontaneous coronary artery dissection, as well as treatment and follow-up.
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Affiliation(s)
- Alberto Berenguer
- Servicio de Cardiología, Hospital General Universitario, Alicante, España.
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38
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Roig S, Gómez JA, Fiol M, Guindo J, Pérez J, Carrillo A, Esplugas E, Bayés de Luna A. Spontaneous coronary artery dissection causing acute coronary syndrome: an early diagnosis implies a good prognosis. Am J Emerg Med 2003; 21:549-51. [PMID: 14655234 DOI: 10.1016/j.ajem.2003.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Spontaneous coronary artery dissection is an unusual cause of acute coronary syndrome. We describe a series of cases that with an early diagnosis and aggressive treatment, which includes percutaneous angioplasty with stent implantation and cardiac surgery, had a good outcome. The objective was to study the demographic characteristics, clinical settings, treatments, and inhospital course of patients with spontaneous coronary artery dissection. We studied a retrospective case series in 3 coronary care units in third-level university hospitals. The spontaneous coronary artery dissection diagnosis was made by coronary angiography. Seven cases of spontaneous coronary artery dissections were recorded. They were 5 women and 2 men. The age range was 28 to 64 years. Two of them took oral contraceptives and one case occurred in the postpartum period. An acute anterior wall myocardial infarction was the most frequent clinical presentation, occurring in 4 of the 7 cases. In fact, the left anterior descending artery was involved in 6 cases. An urgent coronary angiogram was performed in all cases. Definitive treatment included percutaneous angioplasty and stent implantation in 3 cases, coronary artery bypass surgery in 2 case, and cardiac transplantation in another case. One patient was treated medically. None of the patients died in the hospital. Spontaneous coronary artery dissection remains an unusual cause of acute coronary syndrome. It should be included in the differential diagnosis of acute myocardial infarction, especially when it affects young, healthy females. An early clinical suspicion and diagnosis with urgent coronary angiography and aggressive treatment that includes percutaneous angioplasty with stent implantation and cardiac surgery could improve the prognosis of these patients.
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Affiliation(s)
- Sebastian Roig
- Coronary and Intensive Care Unit, Hospital Son Dureta, C/Andrea Doria 55, 07014 Palma de Mallorca, Spain
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39
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Mauser M. False coronary lumen originating from left main coronary artery dissection causing acute myocardial infarction--a case report. Angiology 2003; 54:353-7. [PMID: 12785029 DOI: 10.1177/000331970305400312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction, which is infrequently diagnosed antemortem. The majority of the previously reported cases were found in women of whom a significant proportion presented during pregnancy or the postpartum period. A case is presented of an acute myocardial infarction in a 37-year-old woman, unrelated to pregnancy or the postpartum state, with an unusual spontaneous coronary dissection that was angiographically documented 6 days after thrombolytic therapy. Originating in a small dissection in the left main coronary artery, a false lumen parallel to the left anterior descending coronary artery (LAD) with a separation of the lumina of up to 1 mm was found with a reentry of the false lumen into the LAD in its mid portion. Both lumina were perfused and the true lumen of the LAD showed a 50% to 60% diameter stenosis. Because no signs of ongoing ischemia could be detected at rest or during exercise, the patient was treated medically. Two months later, repeat coronary angiography documented a complete obliteration of the false lumen with moderate stenosis of the proximal LAD. Pathophysiologic aspects and treatment options of spontaneous coronary artery dissections are discussed.
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Affiliation(s)
- Manfred Mauser
- Klinikum Lahr, Medizinische Klinik, Abteilung Kardiologie, Lahr, Germany.
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40
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Johnson WD, Bajwa TK, Allaqaband SQ, Howard MR. Extensive coronary dissection treated with endarterectomy and coronary reconstruction. Ann Thorac Surg 2002; 74:1248-50. [PMID: 12400785 DOI: 10.1016/s0003-4975(02)03861-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acute coronary dissection is an uncommon event, usually not related to typical coronary risk factors, usually in women, and usually diagnosed at autopsy. This report describes a young woman with extensive left anterior descending coronary artery (LAD) dissection, refused for intervention since there was no lesion to angioplasty and no artery to bypass. A long arteriotomy was made, removing under direct vision all of the torn and dissected tissue, just as would be done for extensive LAD endarterectomy. A vein was split and attached to reconstruct the artery. Normal left ventricular function was restored.
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Affiliation(s)
- W Dudley Johnson
- Department of Cardiothoracic Surgery and Cardiology, Sinai Samaritan Hospital, Milwaukee, Wisconsin, USA.
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41
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Maehara A, Mintz GS, Castagna MT, Pichard AD, Satler LF, Waksman R, Suddath WO, Kent KM, Weissman NJ. Intravascular ultrasound assessment of spontaneous coronary artery dissection. Am J Cardiol 2002; 89:466-8. [PMID: 11835932 DOI: 10.1016/s0002-9149(01)02272-x] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Akiko Maehara
- Intravascular Ultrasound Imaging and Cardiac Catheterization Larboratories, Cardiovascular Research Institute, Washington Hospital Center, Washington, DC 20010, USA
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42
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Osula S, Bell GM, Hornung RS. Acute myocardial infarction in young adults: causes and management. Postgrad Med J 2002; 78:27-30. [PMID: 11796868 PMCID: PMC1742222 DOI: 10.1136/pmj.78.915.27] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The case report in this review illustrates an acute myocardial infarction in a young adult probably due to arterial thrombosis that can be attributed to a hypercoagulable state resulting from the nephrotic syndrome. Although rare, acute myocardial infarction should be considered in young adults presenting with chest pain. A detailed clinical history may help to identify the aetiology, and guide subsequent management, but diagnostic coronary angiography is essential. Careful risk factor modification and treatment of the underlying cause should reduce the incidence of recurrent cardiac events.
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Affiliation(s)
- S Osula
- Aintree Cardiac Centre, University Hospital Aintree, Liverpool, UK. tinyonline.co.uk
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43
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Steinhauer JR, Caulfield JB. Spontaneous coronary artery dissection associated with cocaine use: a case report and brief review. Cardiovasc Pathol 2001; 10:141-5. [PMID: 11485859 DOI: 10.1016/s1054-8807(01)00074-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Isolated, spontaneous dissection of the coronary arteries in the absence of trauma is an unusual but well-documented occurrence. Fewer than 50 cases have been reported in males in the English language literature, and only one case, nonfatal, was associated with cocaine use. We present the second overall and the first fatal case of cocaine-associated spontaneous coronary artery dissection and a brief review of the literature on coronary dissection and the cardiovascular effects of cocaine use. The mechanism of cocaine's toxicity on the heart and vasculature is complex, multifactorial, and predominantly related to cocaine's adrenergic properties. The increased arterial blood pressure from cocaine's inotropic and chronotropic effects combined with its direct vasoconstrictive effect leads to increased shear forces on the coronary endothelium. This elevated stress may be responsible for the formation of an intimal tear and the subsequent dissection of the coronary artery. If the dissected portion of the arterial wall is displaced enough to significantly occlude the true lumen, infarction can result. In light of this possibility, coronary artery dissection must be considered in young patients presenting with symptoms of cardiac ischemia and a history of cocaine use.
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Affiliation(s)
- J R Steinhauer
- Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, 523 Kracke Building, 35233-6823, Birmingham, AL, USA
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44
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Timurkaynak T, Boyaci B, Cengel A, Dörtlemez O, Dörtlemez H. Early clinical experience with the implantation of a novel synthetic coronary stent graft. Catheter Cardiovasc Interv 2000; 50:265-7. [PMID: 10842404 DOI: 10.1002/(sici)1522-726x(200006)50:2<265::aid-ccd26>3.0.co;2-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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45
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Affiliation(s)
- M Haude
- University Essen, Department of Cardiology, Essen, Germany
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46
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Abstract
Spontaneous coronary artery dissections are relatively uncommon. Many of the previously reported cases have involved a dissection in a single coronary artery of a peripartum or postpartum female. We describe an unusual case of multiple spontaneous coronary dissections in a middle-aged male.
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Affiliation(s)
- D E Cohen
- Cardiac Catheterization Laboratory, St. Joseph's Hospital and Medical Center, Paterson, New Jersey 07503, USA
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