Spontaneous multivessel coronary artery dissection: repeated presentation in a healthy postmenopausal woman

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) should be considered as a cause of the acute coronary syndrome in young patients with few apparent risk factors for coronary artery disease, in females in the peripartum period, and in patients who are at a higher risk for this condition. SCAD can also present as sudden death and cardiogenic shock. Several mechanisms have been described in the pathophysiology of this condition. Urgent coronary angiography is indicated if SCAD is suspected. Percutaneous coronary artery stenting and coronary artery bypass grafting are the main treatment strategies.

Multivessel spontaneous coronary artery dissection in a postpartum woman treated with multiple drug-eluting stents

Multivessel spontaneous coronary artery dissection is a very rare cause of myocardial ischemia. Its optimal treatment is not yet well defined and is usually tailored to clinical features. We report a case of a postpartum woman with multivessel spontaneous coronary artery dissection and acute myocardial infarction, in whom the drug-eluting stenting of the only alleged 'culprit' vessel did not prevent the propagation of dissection from another vessel. Although the recommendations drawn from a single case report are not conclusive, we believe that when there is a multivessel spontaneous coronary artery dissection in a setting of acute myocardial infarction, all dissected coronary segments should be treated using stents.

Spontaneous coronary artery dissection of the left circumflex artery causing cardiac tamponade and presenting with atrial fibrillation: a case report and review of the literature

Spontaneous coronary artery dissection is rare. When it does occur, it can present in a myriad of ways and can mimic more common clinical scenarios. Undiagnosed it can be fatal. In this article, the authors present a case of coronary artery dissection in a middle aged man presenting as fast atrial fibrillation with hemodynamic compromise. He was unsuccessfully cardioverted and later arrested and died. Postmortem showed a ruptured dissection of the left circumflex artery causing cardiac tamponade and death. Incidence, associations, pathophysiology, investigations, and treatment options are reviewed.

Postpartum spontaneous coronary artery dissection: An important clinical link with anticardiolipin antibody

A 34-year-old woman presented to the Emergency Department with substernal chest pain, 7 days after a normal vaginal delivery. Acute myocardial infarction was diagnosed based on ECG changes and elevated serum troponin levels. Coronary angiography revealed a spontaneous coronary dissection of the left anterior descending (LAD) coronary artery. The patient was managed medically and recovered well clinically with healing of the dissection on repeat angiography 10 days later. Of note the patient had a high titre of anticardiolipin antibody (IgM) detected and this is only the second case described in the literature of an association between spontaneous coronary artery dissection and antiphospholipid antibody syndrome.

Clinical perspectives of the primary spontaneous coronary artery dissection

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome or sudden death. Typically it affects young women during the peripartum period and those using oral contraceptives. The pathophysiology remains unclear, but an eosinophilic periadventitial inflammation has been commonly observed in such cases. Unlike atherosclerotic intimal dissection, the dissection plane in the spontaneous dissection lies within the media or between the media and adventitia. Due to the rarity of the condition, the optimal management of the spontaneous coronary artery dissection has not been established and it may range from conservative medical treatment to percutaneous or surgical interventions depending upon the anatomy of the dissection, compromise of the vessel lumen and the clinical circumstances. The reported prognosis varies widely. Spontaneous coronary artery dissection should be considered in the differential diagnosis in young persons with precordial chest pain, especially women in the peripartum state and those using oral contraceptives. The clinical perspectives of the primary spontaneous coronary artery dissection are elaborated.

Unique spontaneous unhealed chronic multivessel coronary artery dissection in an elderly man: a case report and review of the literature

Spontaneous coronary artery dissection (SCAD) is relatively uncommon. It often occurs in healthy, middle-aged women without overt risk factors for atherosclerosis and is associated with the peripartum period. The pattern and severity of presentation are variable. There are only 5 reports in the literature about multivessel involvement. The etiopathogenesis of SCAD is unclear. Treatment strategy is not standard but is usually tailored to clinical features. Long-term survival of patients with SCAD who have had no problem at the initial event is good. The authors report the first case of unhealed chronic multivessel SCAD in the literature.

Spontaneous coronary artery dissection

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.

Acute Myocardial Infarction from Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection is a rare event as a cause of acute myocardial infarction. Optimal treatment remains unclear. In this report, we describe a case of spontaneous acute coronary artery dissection presenting as recurrent acute myocardial infarction in a postmenopausal woman, successfully treated with systemic thrombolysis. The case is discussed with review of the pertinent literature.