1
|
Huang F, Khellaf LR, Lefèvre G, Berti A, d'Humières T, Sionis A, Solé AA, Bello F, Bermeo Garrido JA, Crickx E, Delvino P, Emmi G, Gaillet A, Garcia G, Gavand PE, George JL, Gilles F, Golden C, de Groote P, Guffroy A, Martis N, Monti S, Mourlanette P, Pineton de Chambrun M, Prunier F, Regola F, Seret G, Terrier B, Tréfond L, Souteyrand G, Varenne O, Zilio F, Haziza F, Benamer H, Kahn JE, Vallée A, Groh M. Clinical picture, outcomes, and predictors of relapse in eosinophilia-associated coronary vasospasm: Data from a European multicentric study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1377-1381.e2. [PMID: 38307204 DOI: 10.1016/j.jaip.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Florent Huang
- ACTION Study Group, Department of Cardiology, Foch Hospital, Suresnes, France; French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Lucas Rémi Khellaf
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Guillaume Lefèvre
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; Department of Internal Medicine and Clinical Immunology, University of Lille, CHU de Lille, Lille, France; Inserm U1286 Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France
| | - Alvise Berti
- Center for Medical Sciences, Department of Cellular, Computational, and Integrative Biology, University of Trento, Trento, Italy; Rheumatology Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari Trento, Trento, Italy
| | - Thomas d'Humières
- Physiology Department, CHU Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Ariza Solé
- Intensive Cardiac Care Unit, Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy; Interdisciplinary Internal Medicine Unit, Behçet Centre and Lupus Clinic, AOU Careggi Hospital of Firenze, Firenze, Italy
| | - Juan Andres Bermeo Garrido
- Intensive Cardiac Care Unit, Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Etienne Crickx
- Internal Medicine Department, Centre National de Référence des Cytopénies Auto-immunes de l'Adulte, Hôpital Henri Mondor, Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Assistance Publique Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Paolo Delvino
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy; Interdisciplinary Internal Medicine Unit, Behçet Centre and Lupus Clinic, AOU Careggi Hospital of Firenze, Firenze, Italy; Centre for Inflammatory Diseases, Department of Medicine, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Antoine Gaillet
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; Medical Intensive Care Unit, Hôpitaux Universitaires Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Gilles Garcia
- Department of Pulmonology, Antony Private Hospital, Antony, France
| | | | - Jean-Louis George
- Department of Cardiology, Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay-Rocquencourt, France
| | - Floriane Gilles
- Department of Cardiology, Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay-Rocquencourt, France
| | | | - Pascal de Groote
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; CHU Lille, Service de Cardiologie, Lille, France; Inserm U1167, Institut Pasteur de Lille, Lille, France
| | - Aurélien Guffroy
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiencies, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nihal Martis
- Internal Medicine Department, Hôpital de Larchet, University Hospital of Nice, Côte d'Azur University, Nice, France
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | | | - Marc Pineton de Chambrun
- Department of Intensive Care Medicine, APHP, Sorbonne Université, Pitié Salpétrière, Paris, France
| | - Fabrice Prunier
- Department of Cardiology, Universitary Hospital of Angers, Angers, France
| | - Francesca Regola
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Gabriel Seret
- Department of Cardiology, University of Sorbonne-Paris Cité, APHP, Cochin Hospital, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, APHP, Paris, France
| | - Ludovic Tréfond
- Internal Medicine, Gabriel Montpied Hospital, Clermond-Ferrand, France
| | - Géraud Souteyrand
- Department of Cardiology, Gabriel Montpied Hospital, Clermond-Ferrand, France
| | - Olivier Varenne
- Department of Cardiology, University of Sorbonne-Paris Cité, APHP, Cochin Hospital, Paris, France
| | - Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari Trento, Trento, Italy
| | - Franck Haziza
- ACTION Study Group, Department of Cardiology, Foch Hospital, Suresnes, France
| | - Hakim Benamer
- ACTION Study Group, Department of Cardiology, Foch Hospital, Suresnes, France
| | - Jean-Emmanuel Kahn
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France; Department of Internal Medicine, University of Paris Saclay, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
| | - Matthieu Groh
- French National Reference Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Foch Hospital, Suresnes, France.
| |
Collapse
|
2
|
Yang C, Offen S, Saw J. What Is New in Spontaneous Coronary Artery Dissection? CJC Open 2024; 6:417-424. [PMID: 38487071 PMCID: PMC10935686 DOI: 10.1016/j.cjco.2023.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/03/2023] [Indexed: 03/17/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a condition that leads to tearing of the coronary vessel wall in the absence of trauma, iatrogenic injury, or atherosclerosis. SCAD is an important cause of myocardial infarction in young women, leading to significant cardiovascular morbidity and mortality. Within cohorts of women aged around 50 years on average, who experience acute coronary syndrome, the prevalence of SCAD is 22.5%- 35%. Over the past decade, SCAD research has expanded rapidly, leading to improved understanding of this condition. In this review, we provide a summary of the current body of knowledge, highlight areas of ongoing research, and identify existing knowledge gaps. Specifically, we provide a focused update on the pathogenesis of SCAD, including genetic and associated conditions, clinical presentation and diagnosis, prognosis, and short-term and long-term management. Highlighted areas include the following: insights from recent genome-wide association studies; intracoronary imaging for the diagnosis of SCAD; the role of cardiac computed tomography angiography to assess for vessel healing; revascularization strategies and challenges; cardiogenic shock in SCAD; and the increasingly recognized burden of anxiety, depression, and posttraumatic stress disorder among SCAD patients.
Collapse
Affiliation(s)
- Cathevine Yang
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sophie Offen
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
3
|
Xu X, Zhang G, Li Z, Li D, Chen R, Huang C, Li Y, Li B, Yu H, Chu XM. MINOCA biomarkers: Non-atherosclerotic aspects. Clin Chim Acta 2023; 551:117613. [PMID: 37871762 DOI: 10.1016/j.cca.2023.117613] [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: 08/24/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/25/2023]
Abstract
Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) is an important subtype of myocardial infarction. Although comprising less than 50% stenosis in the main epicardial coronary arteries, it constitutes a severe health risk. A variety of approaches have been recommended, but definitive diagnosis remains elusive. In addition, the lack of a comprehensive understanding of underlying pathophysiology makes clinical management difficult and unpredictable. This review highlights ongoing efforts to identify relevant biomarkers in MINOCA to improve diagnosis, individualize treatment and better predict outcomes.
Collapse
Affiliation(s)
- Xiaojian Xu
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266100, China.
| | - Guoliang Zhang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266100, China.
| | - Zhaoqing Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266100, China.
| | - Daisong Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266100, China.
| | - Ruolan Chen
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266100, China.
| | - Chao Huang
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266100, China.
| | - Yonghong Li
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266100, China.
| | - Bing Li
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao 266000, China; Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
| | - Haichu Yu
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266100, China.
| | - Xian-Ming Chu
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao 266100, China; The Affiliated Cardiovascular Hospital of Qingdao University, Qingdao 266071, China.
| |
Collapse
|
4
|
Özkan U, Gürdoğan M. TyG index as a predictor of spontaneous coronary artery dissection in young women. Postgrad Med 2023; 135:669-675. [PMID: 37503966 DOI: 10.1080/00325481.2023.2242760] [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: 03/08/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Spontaneous coronary artery dissection (SCAD) is a rare but potentially life-threatening pathology and cases are especially seen in women under 50 years of age and with relatively fewer cardiovascular risk factors. Although risk factors facilitating the development of SCAD have been defined in the literature, modifiable risk factors remain unclear. In this study, it was aimed to investigate the relationship between the triglyceride glucose index (TyG) and the development of SCAD in the population of young women. METHODS The results of 281 patients were analyzed and compared with each other in terms of clinical, demographic, laboratory parameters, and coronary angiography results. RESULTS The mean age was 45 years and all of them were female. When the groups were compared, the TyG and inflammatory parameters were higher in the SCAD group (p < 0.001). When these two groups with low cardiovascular risk factors were compared in logistic regression analysis, high TyG was found to be an independent predictor of SCAD development in young women (p < 0.001). CONCLUSION As a result, our study shows that the development of these non-atherosclerotic conditions can be predicted by simple biochemical tests in young women with low atherosclerotic cardiovascular risk factors.
Collapse
Affiliation(s)
- Uğur Özkan
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
| | - Muhammet Gürdoğan
- Department of Cardiology, School of Medicine, Trakya University, Edirne, Turkey
| |
Collapse
|
5
|
Gurgoglione FL, Rizzello D, Giacalone R, Ferretti M, Vezzani A, Pfleiderer B, Pelà G, De Panfilis C, Cattabiani MA, Benatti G, Tadonio I, Grassi F, Magnani G, Noni M, Cancellara M, Nicolini F, Ardissino D, Vignali L, Niccoli G, Solinas E. Precipitating factors in patients with spontaneous coronary artery dissection: Clinical, laboratoristic and prognostic implications. Int J Cardiol 2023; 385:1-7. [PMID: 37211051 DOI: 10.1016/j.ijcard.2023.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) often presents with acute coronary syndrome and underlying pathophysiology involves the interplay between predisposing factors and precipitating stressors, such as emotional and physical triggers. In our study we sought to compare clinical, angiographic and prognostic features in a cohort of patients with SCAD according to the presence and type of precipitating stressors. METHODS Consecutive patients with angiographic evidence of SCAD were divided into three groups: patients with emotional stressors, patients with physical stressors and those without any stressor. Clinical, laboratoristic and angiographic features were collected for each patient. The incidence of major adverse cardiovascular events, recurrent SCAD and recurrent angina was assessed at follow-up. RESULTS Among the total population (64 subjects), 41 [64.0%] patients presented with precipitating stressors, including emotional triggers (31 [48.4%] subjects) and physical efforts (10 [15.6%] subjects). As compared with the other groups, patients with emotional triggers were more frequently female (p = 0.009), had a lower prevalence of hypertension (p = 0.039] and dyslipidemia (p = 0.039), were more likely to suffer from chronic stress (p = 0.022) and presented with higher levels of C-reactive protein (p = 0.037) and circulating eosinophils cells (p = 0.012). At a median follow-up of 21 [7; 44] months, patients with emotional stressors experienced higher prevalence of recurrent angina (p = 0.025), as compared to the other groups. CONCLUSIONS Our study shows that emotional stressors leading to SCAD may identify a SCAD subtype with specific features and a trend towards a worse clinical outcome.
Collapse
Affiliation(s)
| | - Davide Rizzello
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy
| | | | - Marco Ferretti
- Division of Cardiology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Antonella Vezzani
- Cardiac Surgery Intensive Care Unit, Parma University Hospital, Parma, Italy
| | | | - Giovanna Pelà
- Department of Medicine and Surgery, University of Parma, Italy
| | | | | | - Giorgio Benatti
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Iacopo Tadonio
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Giulia Magnani
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Manjola Noni
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Francesco Nicolini
- Division of Cardio surgery, University of Parma, Parma University Hospital, Parma, Italy
| | - Diego Ardissino
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy
| | - Luigi Vignali
- Division of Cardiology, Parma University Hospital, Parma, Italy
| | - Giampaolo Niccoli
- Division of Cardiology, University of Parma, Parma University Hospital, Parma, Italy.
| | - Emilia Solinas
- Division of Cardiology, Parma University Hospital, Parma, Italy
| |
Collapse
|
6
|
Backhouse B, Scully T, Rajakariar K, Jin D, Chandrasekhar J, Freeman M. Coronary Artery Vasospasm in Patients With Eosinophilia. JACC Case Rep 2023; 19:101932. [PMID: 37593590 PMCID: PMC10429275 DOI: 10.1016/j.jaccas.2023.101932] [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: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 08/19/2023]
Abstract
Coronary vasospasm is a relatively well-documented cause for ischemia and myocardial infarction in patients with nonobstructive coronary artery disease. Patients with coexisting eosinophilia present with severe manifestations and are often refractory to traditional therapies. There are few reported cases in the literature. We describe 3 cases occurring within 10 months. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
| | - Timothy Scully
- Department of Cardiology, Eastern Health, Melbourne, Australia
| | | | - David Jin
- Department of Cardiology, Eastern Health, Melbourne, Australia
| | - Jaya Chandrasekhar
- Department of Cardiology, Eastern Health, Melbourne, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Melbourne, Australia
| |
Collapse
|
7
|
Cottin V. Eosinophilic Lung Diseases. Immunol Allergy Clin North Am 2023; 43:289-322. [PMID: 37055090 DOI: 10.1016/j.iac.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
The eosinophilic lung diseases may manifest as chronic eosinophilic pneumonia, acute eosinophilic pneumonia, or as the Löffler syndrome (generally of parasitic etiology). The diagnosis of eosinophilic pneumonia is made when both characteristic clinical-imaging features and alveolar eosinophilia are present. Peripheral blood eosinophils are generally markedly elevated; however, eosinophilia may be absent at presentation. Lung biopsy is not indicated except in atypical cases after multidisciplinary discussion. The inquiry to possible causes (medications, toxic drugs, exposures, and infections especially parasitic) must be meticulous. Idiopathic acute eosinophilic pneumonia may be misdiagnosed as infectious pneumonia. Extrathoracic manifestations raise the suspicion of a systemic disease especially eosinophilic granulomatosis with polyangiitis. Airflow obstruction is frequent in allergic bronchopulmonary aspergillosis, idiopathic chronic eosinophilic pneumonia, eosinophilic granulomatosis with polyangiitis, and hypereosinophilic obliterative bronchiolitis. Corticosteroids are the cornerstone of therapy, but relapses are common. Therapies targeting interleukin 5/interleukin-5 are increasingly used in eosinophilic lung diseases.
Collapse
Affiliation(s)
- Vincent Cottin
- Service de pneumologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Centre de référence coordonnateur des maladies pulmonaires rares (OrphaLung), 28 Avenue Doyen Lepine, Lyon Cedex 69677, France; Université Lyon 1, INRAE, UMR754, Lyon, France.
| |
Collapse
|
8
|
Alemzadeh‐Ansari MJ, Fakhrabadi AA, Amin A, Rafiee F, Houshmand G. Spontaneous coronary artery dissection in a patient with recent COVID-19 infection: A case report. Clin Case Rep 2022; 10:e6399. [PMID: 36225616 PMCID: PMC9529755 DOI: 10.1002/ccr3.6399] [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: 04/06/2022] [Revised: 08/01/2022] [Accepted: 09/20/2022] [Indexed: 01/09/2023] Open
Abstract
We report a spontaneous coronary artery dissection (SCAD) case in a lady with a history of recent COVID-19 and without any known predisposing factors. We also highlight the value of CMR as a noninvasive tool for tissue characterization, which can also be more applicable during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Mohammad Javad Alemzadeh‐Ansari
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Amir Akbar Fakhrabadi
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Ahmad Amin
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Farnaz Rafiee
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Golnaz Houshmand
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| |
Collapse
|
9
|
Khiatah B, Jazayeri S, Yamamoto N, Burt T, Frugoli A, Brooks DL. Cardiovascular disease in women: A review of spontaneous coronary artery dissection. Medicine (Baltimore) 2022; 101:e30433. [PMID: 36197250 PMCID: PMC9509023 DOI: 10.1097/md.0000000000030433] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/28/2022] [Indexed: 11/27/2022] Open
Abstract
Research has demonstrated the disproportionate quality of care for women with cardiovascular disease. These findings have prompted a renewed focus on cardiovascular disease awareness and disease prevention in women. Spontaneous coronary artery dissection (SCAD) is a significant cause of myocardial infarction (MI) and sudden death that primarily affects women. ongoing research has led to improved diagnostic capabilities and changes in approaches to initial and long-term management most importantly this research has provided evidence that SCAD is more common than previously thought and must be evaluated and treated differently from atherosclerotic MI. The difference between SCAD and atherosclerotic MI is highlighted in high rates of recurrent disease, gender distribution, association with exogenous hormones, pregnancy, migraine, physical and emotional stress triggers, concurrent systemic arteriopathies, and connective tissue disease. In this review, we provide updated insights and a summary of the epidemiology, risk factors, clinical presentation, diagnosis, treatment options, prognosis, and recurrence prevention of SCAD. We aim to provide a review of SCAD as a focus on cardiovascular disease awareness and disease prevention in women.
Collapse
Affiliation(s)
- Bashar Khiatah
- Community Memorial Hospital, Internal Medicine Department, Ventura, CA, USA
| | - Sam Jazayeri
- Community Memorial Hospital, Internal Medicine Department, Ventura, CA, USA
| | - Naofumi Yamamoto
- College of Osteopathic Medicine of the Pacific, Western University, Pomona, CA, USA
| | - Tristen Burt
- College of Osteopathic Medicine of the Pacific, Western University, Pomona, CA, USA
| | - Amanda Frugoli
- Community Memorial Hospital, Internal Medicine Department, Ventura, CA, USA
| | | |
Collapse
|
10
|
Jaspan VN, Rapkiewicz AV, Reynolds HR. The presence of thrombus in spontaneous coronary artery dissection: A systematic review of autopsy findings. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 15:100135. [PMID: 38558756 PMCID: PMC10978323 DOI: 10.1016/j.ahjo.2022.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 04/04/2024]
Abstract
Background Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in young women. There is no consensus on optimal treatment, though a conservative approach including antiplatelet agents is commonly used. We hypothesized that most cases of SCAD would not demonstrate true lumen thrombus in the dissected artery, suggesting that anti-platelet agents might not have a role in the treatment of SCAD. Methods We conducted a systematic review of the published literature through March 2022 to identify pathology images from individuals who died of SCAD. The images were independently reviewed by a pathologist to assess for the presence of thrombus and inflammatory cells. Results We identified 40 cases from 34 publications with available pathology images and found only one case of true lumen thrombus. Additionally, we found that 53% of cases involved eosinophilic inflammation. Conclusion The role of antiplatelet agents in the treatment of SCAD should be re-evaluated. Further studies are needed to better understand the significance and treatment implications of eosinophilic inflammation.
Collapse
Affiliation(s)
- Vita N. Jaspan
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, United States of America
| | - Amy V. Rapkiewicz
- Department of Pathology, NYU Long Island School of Medicine, United States of America
| | - Harmony R. Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, United States of America
| |
Collapse
|
11
|
Teruzzi G, Santagostino Baldi G, Gili S, Guarnieri G, Montorsi P, Trabattoni D. Spontaneous Coronary Artery Dissections: A Systematic Review. J Clin Med 2021; 10:jcm10245925. [PMID: 34945221 PMCID: PMC8706333 DOI: 10.3390/jcm10245925] [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: 12/04/2021] [Revised: 12/12/2021] [Accepted: 12/15/2021] [Indexed: 01/17/2023] Open
Abstract
Myocardial infarction with nonobstructive coronary artery disease due to spontaneous coronary artery dissection (SCAD) accounts for 5–8% of acute coronary syndrome (ACS) presentations. The demographic characteristics, risk factors, and management of patients with SCAD differ from those with atherosclerotic disease. The objective of this review is to provide a contemporary understanding of the epidemiology, pathophysiology, clinical presentation, and management of SCAD.
Collapse
Affiliation(s)
- Giovanni Teruzzi
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
| | - Giulia Santagostino Baldi
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
| | - Sebastiano Gili
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
| | - Gianluca Guarnieri
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
| | - Piero Montorsi
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Daniela Trabattoni
- Centro Cardiologico Monzino, IRCCS, Invasive Cardiology Department, 20138 Milan, Italy; (G.T.); (G.S.B.); (S.G.); (G.G.); (P.M.)
- Correspondence: ; Tel.: +39-025-800-2546
| |
Collapse
|
12
|
Margaritis M, Saini F, Baranowska-Clarke AA, Parsons S, Vink A, Budgeon C, Alcock N, Wagner BE, Samani NJ, von der Thüsen J, Robertus JL, Sheppard MN, Adlam D. Vascular histopathology and connective tissue ultrastructure in spontaneous coronary artery dissection: pathophysiological and clinical implications. Cardiovasc Res 2021; 118:1835-1848. [PMID: 34048532 PMCID: PMC9215198 DOI: 10.1093/cvr/cvab183] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/27/2021] [Indexed: 12/21/2022] Open
Abstract
Aims Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndromes
and in rare cases sudden cardiac death (SCD). Connective tissue abnormalities, coronary
inflammation, increased coronary vasa vasorum (VV) density, and
coronary fibromuscular dysplasia have all been implicated in the pathophysiology of SCAD
but have not previously been systematically assessed. We designed a study to investigate
the coronary histological and dermal collagen ultrastructural findings in SCAD. Methods and results Thirty-six autopsy SCAD cases were compared with 359 SCAD survivors. Coronary and
myocardial histology and immunohistochemistry were undertaken. Transmission electron
microscopy (TEM) of dermal extracellular matrix (ECM) components of
n = 31 SCAD survivors and n = 16 healthy volunteers
were compared. Autopsy cases were more likely male (19% vs. 5%;
P = 0.0004) with greater proximal left coronary involvement (56% vs.
18%; P < 0.0001) compared to SCAD survivors. N = 24
(66%) of cases showed no myocardial infarction on macro- or microscopic examination
consistent with arrhythmogenic death. There was significantly
(P < 0.001) higher inflammation in cases with delayed-onset death
vs. sudden death and significantly more inflammation surrounding the dissected vs.
non-dissected vessel segments. N = 17 (47%) cases showed limited
intimal fibro-elastic thickening but no features of fibromuscular dysplasia and no
endothelial or internal elastic lamina abnormalities. There were no differences in VV
density between SCAD and control cases. TEM revealed no general ultrastructural
differences in ECM components or markers of fibroblast metabolic activity. Conclusions Assessment of SCD requires careful exclusion of SCAD, particularly in cases without
myocardial necrosis. Peri-coronary inflammation in SCAD is distinct from vasculitides
and likely a reaction to, rather than a cause for SCAD. Coronary fibromuscular dysplasia
or increased VV density does not appear pathophysiologically important. Dermal
connective tissue changes are not common in SCAD survivors.
Collapse
Affiliation(s)
- Marios Margaritis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Francesca Saini
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Ania A Baranowska-Clarke
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine and Department of Forensic Medicine, Monash University, Melbourne Victoria
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Charley Budgeon
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.,Australia & School of Population and Global Health, University of Western Australia, Perth, Western Australia
| | - Natalie Alcock
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Bart E Wagner
- Electron Microscopy, Histopathology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Jan von der Thüsen
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Lukas Robertus
- Department of Pathology, Royal Brompton Hospital, London, United Kingdom
| | - Mary N Sheppard
- CRY Department of Cardiovascular Pathology, Molecular and Clinical Sciences Research Institute, St Georges Medical School, London, United Kingdom
| | - David Adlam
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| |
Collapse
|
13
|
An Autopsy Case of Spontaneous Coronary Artery Dissection With Eosinophilic Coronary Periarteritis and Degeneration of Medial Smooth Muscles. Am J Forensic Med Pathol 2021; 42:387-391. [PMID: 33853104 DOI: 10.1097/paf.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 45-year-old woman with no known medical history died suddenly shortly after complaining of anterior chest discomfort. The autopsy revealed a dissection at the anterior descending branch of the left coronary artery, and eosinophilic adventitial inflammation was observed both in the right coronary artery and in the vicinity of the dissection. Furthermore, there was degeneration of the tunica media in the right coronary artery, and this was thought to be a predissection lesion. In the degenerated area of the tunica media, probable apoptosis of smooth muscle cells was noted, suggesting that the degeneration was not due only to the effect of eosinophilic lytic enzymes. These findings also indicated that eosinophilic infiltration preceded the dissection. Eosinophilic infiltration around the coronary arteries is occasionally observed in cases of sudden death, but although it might be associated with the death, the pathological mechanism is yet to be elucidated. Eosinophilic periarteritis has also been observed around the site of spontaneous coronary artery dissection, although a causal relationship is unproven. The histopathology of this case indicated that the eosinophilic infiltration preceded the dissection. Detailed pathological findings are presented, together with a review of the literature.
Collapse
|
14
|
Namal Rathnayaka RMMK, Nishanthi Ranathunga PEA, Kularatne SAM. Kounis Syndrome Following Hypnale zara (Hump-Nosed Pit Viper) Bite in Sri Lanka. Wilderness Environ Med 2021; 32:210-216. [PMID: 33775497 DOI: 10.1016/j.wem.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
A 47-y-old man was bitten by a hump-nosed viper (Hypnale zara) and gradually developed retrosternal chest pain associated with ST segment elevation on electrocardiogram. He had normal troponin I levels and no evidence of coagulopathy. Initially, he was managed as having anterior ST elevation myocardial infarction with thrombolysis. Later, because troponin levels were normal, he was suggested to have the type I variant of Kounis syndrome (allergic coronary artery spasm). This was supported by high eosinophil counts in peripheral blood. He was successfully managed with supportive treatment and discharged 6 d after the snakebite. Cardiac complications are rarely reported after hump-nosed viper bites, and clinical reports of coronary vasospasm after snakebites are extremely rare in the literature. This is the first known report of Kounis syndrome after a hump-nosed viper bite.
Collapse
Affiliation(s)
- R M M K Namal Rathnayaka
- Intensive Care Unit, Teaching Hospital Ratnapura, Sri Lanka; Department of Pharmacology, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Hidellana, Ratnapura; Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peredeniya, Sri Lanka.
| | | | - S A M Kularatne
- Faculty of Medicine, University of Peradeniya, Peredeniya, Sri Lanka
| |
Collapse
|
15
|
Affiliation(s)
- Esther S H Kim
- From the Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville
| |
Collapse
|
16
|
Arai R, Migita S, Koyama Y, Homma T, Saigusa N, Akutsu N, Fukamachi D, Okumura Y, Hao H. Imaging and Pathology of Eosinophilic Coronary Periarteritis. JACC Cardiovasc Interv 2020; 13:e151-e154. [PMID: 32739300 DOI: 10.1016/j.jcin.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/05/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Riku Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Suguru Migita
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan; Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yutaka Koyama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan; Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Taku Homma
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Natsuki Saigusa
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Naotaka Akutsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Hao
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan.
| |
Collapse
|
17
|
Izadpanah P, Shaabani S, Heiran A. Fatal eosinophilic coronary periarteritis leads to dissection in a young patient: A case report. J Cardiol Cases 2020; 21:67-70. [PMID: 32042358 DOI: 10.1016/j.jccase.2019.09.014] [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: 07/03/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022] Open
Abstract
Eosinophilic coronary periarteritis (ECPA) is a poorly studied type of coronary arteritis. It causes myocardial ischemia and most cases are diagnosed at autopsy. We report the case of a 35-year-old woman who presented with sudden unexpected cardiac arrest and was brought to the emergency ward. Cardiopulmonary resuscitation was started by ambulance paramedic. On arrival, the patient was transferred to the catheterization laboratory due to sudden aborted cardiac death. The angiography was performed and dissection of the left main coronary artery, extended to the left anterior descending artery was detected. Pathological study confirmed ECPA. It appears that young and healthy patients with a history of intermittent vasospastic angina should be evaluated for ECPA. <Learning objective: Young and healthy patients with a history of intermittent Prinzmetal vasospastic angina should be evaluated for eosinophilic coronary periarteritis (ECPA) prior to sudden cardiac death. Since ECPA is an unexpected and life-threatening condition, developing a diagnostic tool amongst suspicious young and healthy patients is demanded. Positron emission tomography-computed tomography might be an interesting tool, since it can detect infiltrative cells in early stages of cardiac inflammatory disease.>.
Collapse
Affiliation(s)
- Payman Izadpanah
- Alzahra Cardiovascular Charitable Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sonia Shaabani
- Alzahra Cardiovascular Charitable Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Heiran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
18
|
"Idiopathic Eosinophilic Vasculitis": Another Side of Hypereosinophilic Syndrome? A Comprehensive Analysis of 117 Cases in Asthma-Free Patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:1329-1340.e3. [PMID: 31863912 DOI: 10.1016/j.jaip.2019.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/28/2019] [Accepted: 12/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The absence of asthma may rule out a diagnosis of eosinophilic granulomatosis with polyangiitis in patients with hypereosinophilic syndrome (HES) and features of vasculitis. OBJECTIVE To describe eosinophilic vasculitis (EoV) as a possible manifestation of HES in asthma-free patients. METHODS We screened our hospital database and the literature for patients with HES who met the following 4 criteria: (1) histopathological or clinical features of EoV (biopsy-proven vasculitis with predominant eosinophilic infiltration of the vessel wall and/or features of vasculitis with tissue and/or blood hypereosinophilia [absolute eosinophil count >1.5 G/L]); (2) no other obvious causes of reactive eosinophilia, organ damage, and vasculitis; (3) the absence of antineutrophil cytoplasmic antibodies; and (4) the absence of current asthma. RESULTS Ten of our 83 (12%) asthma-free patients with HES and 107 additional cases in the literature met the criteria for EoV. After a critical analysis of the patients' clinical and laboratory characteristics and outcomes, we identified 41 cases of single-organ EoV (coronary arteritis, n = 29; temporal arteritis, n = 8; cerebral vasculitis, n = 4). Of the remaining 76 patients with EoV, the most frequent manifestations (>10%) were cutaneous vasculitis (56%), peripheral neuropathy (24%), thromboangiitis obliterans-like disease (16%), fever (13%), central nervous system involvement (13%), deep venous thrombosis (12%), and nonasthma lung manifestations (12%). Blood hypereosinophilia more than 1.5 G/L was observed in 79% of patients, and necrotizing vasculitis was observed in 44%. CONCLUSIONS Our results suggest that idiopathic EoV (HES-associated vasculitis) can be classified as an eosinophilic-rich, necrotizing, systemic form of vasculitis that affects vessels of various sizes in asthma-free patients.
Collapse
|
19
|
Conti L, Gatt K, Zammit C, Cassar K. Kounis syndrome uncovers severe coronary disease: an unusual case of acute coronary syndrome secondary to allergic coronary vasospasm. BMJ Case Rep 2019; 12:12/12/e232472. [DOI: 10.1136/bcr-2019-232472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute coronary syndrome occurring during the course of a type I hypersensitivity reaction constitutes Kounis syndrome. We report a case of a 64-year-old man who presented with a non-ST elevation myocardial infarction and peripheral blood eosinophilia. He had rhinitis and constitutional symptoms for several days prior to presentation. Blood investigations revealed moderate eosinophilia and elevated IgE levels. A cardiac MRI showed generalised oedema with a subtle wall motion abnormality in basal inferior/inferolateral wall, and subendocardial high signal on late gadolinium enhancement suggesting a localised myocardial infarction. A coronary angiogram then revealed triple vessel disease. A diagnosis of Kounis syndrome was made. Within days of starting appropriate treatment, the patient’s eosinophil count returned to normal with improvement of clinical picture.
Collapse
|
20
|
Ichimata S, Hata Y, Nishida N. An autopsy case of sudden unexpected death with loxoprofen sodium-induced allergic eosinophilic coronary periarteritis. Cardiovasc Pathol 2019; 44:107154. [PMID: 31760242 DOI: 10.1016/j.carpath.2019.107154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/26/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022] Open
Abstract
Although the cause of eosinophilic coronary periarteritis (ECPA) remains unclear, an allergic background is present in fewer patients than expected. A 50-year-old man with no history of allergy or symptoms suggestive of cardiac or respiratory disorders suddenly died shortly after oral administration of loxoprofen sodium. Autopsy showed eosinophilic coronary periarteritis in three main branches of the coronary arteries, characterized by eosinophil-predominant inflammation without fibrinoid necrosis or granulomatous change in the adventitia and its surroundings of the three main branches of the coronary arteries, in addition to the localized sign of bronchial asthma in the lung. Immunohistochemical examination showed that many mast cells positive for human mast cell tryptase were evident in the perivascular tissue containing peripheral nerve trunks. Whereas the blood concentration of loxoprofen sodium was within the therapeutic range, significant elevation of the serum histamine and tryptase levels was found. The present case suggests that eosinophilic coronary periarteritis may be caused by a type I allergic reaction in some patients and that loxoprofen sodium can trigger a life-threatening type I allergic reaction, including eosinophilic coronary periarteritis, leading to sudden unexpected death.
Collapse
Affiliation(s)
- Shojiro Ichimata
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Yukiko Hata
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan.
| |
Collapse
|
21
|
Buja LM, Zehr B, Lelenwa L, Ogechukwu E, Zhao B, Dasgupta A, Barth RF. Clinicopathological complexity in the application of the universal definition of myocardial infarction. Cardiovasc Pathol 2019; 44:107153. [PMID: 31760238 DOI: 10.1016/j.carpath.2019.107153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/28/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022] Open
Abstract
A universal definition of myocardial infarction (UDMI) has been established, periodically updated, and refined over the past twenty years. The primary purpose of the UDMI is to bring uniformity and accuracy to clinical diagnosis. Herein, a review and analysis of the UDMI is presented with emphasis on clinicopathological correlation. Determination of the presence of myocardial injury is based on the detection of abnormal serum cardiac biomarkers, particularly cardiac troponin (cTn), and in the current fourth iteration of the UDMI, high sensitivity (hs)-cTn. Differentiation of myocardial infarction from other causes of myocardial injury requires the documentation of clinical evidence of myocardial ischemia. In this review, difficulties in applying the UDMI in actual practice are discussed, based on the experience and perspective of those of us who face these problems as part of our own practice of pathology. The complexity in application of the UDMI is highlighted by the presentation of five illustrative cases involving the differential diagnosis of myocardial injury and myocardial infarction due to atherothrombotic and nonatherothrombotic coronary artery disease. The cases include myocardial infarction due to severe coronary atherosclerosis, supply-demand mismatch, coronary artery dissection associated with an eosinophilic coronary periarteritis, and coronary thromboembolism, and a case with a differential diagnosis of myocarditis and myocardial infarction. These cases illustrate how pathological findings can contribute to more accurate application of the UDMI and how, when critically applied, the UDMI can be used to better characterize myocardial infarcts in clinical practice.
Collapse
Affiliation(s)
- Louis Maximilian Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), United States.
| | - Bradley Zehr
- Department of Pathology, The Ohio State University (OSU), United States
| | - Laura Lelenwa
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), United States
| | - Eze Ogechukwu
- Department of Pathology, The Ohio State University (OSU), United States
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), United States
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), United States
| | - Rolf F Barth
- Department of Pathology, The Ohio State University (OSU), United States
| |
Collapse
|
22
|
Ford TJ, Berry C. How to Diagnose and Manage Angina Without Obstructive Coronary Artery Disease: Lessons from the British Heart Foundation CorMicA Trial. Interv Cardiol 2019; 14:76-82. [PMID: 31178933 PMCID: PMC6545998 DOI: 10.15420/icr.2019.04.r1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 04/17/2019] [Indexed: 01/15/2023] Open
Abstract
Patients with symptoms and/or signs of ischaemia but no obstructive coronary artery disease (INOCA) present a diagnostic and therapeutic challenge. Microvascular and/or vasospastic angina are the two most common causes of INOCA; however, invasive coronary angiography lacks the sensitivity to diagnose these functional coronary disorders. In this article, the authors summarise the rationale for invasive testing in the absence of obstructive coronary disease, namely that correct treatment for angina patients starts with the correct diagnosis. They provide insights from the CORonary MICrovascular Angina (CorMicA) study, where an interventional diagnostic procedure was performed with linked medical therapy to improve patient health. Identification of these distinct disorders (microvascular angina, vasospastic angina or non-cardiac chest pain) is key for stratifying INOCA patients, allowing prognostic insights and better patient care with linked therapy based on contemporary guidelines. Finally, they propose a framework to diagnose and manage patients in this common clinical scenario.
Collapse
Affiliation(s)
- Thomas J Ford
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow UK
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow UK
| |
Collapse
|
23
|
Sudden unexpected death due to coronary thrombosis associated with isolated necrotizing vasculitis in the coronary arteries of a young adult. Forensic Sci Med Pathol 2019; 15:252-257. [PMID: 30810977 DOI: 10.1007/s12024-019-00099-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2019] [Indexed: 12/18/2022]
Abstract
Coronary arteritis is an uncommon cause of sudden death in non-atherosclerotic coronary diseases, and is mostly associated with systemic vasculitis or systemic autoimmune diseases; therefore, sudden death due to isolated coronary arteritis rarely occurs. The case described in this report is that of a 34-year-old man with no significant personal medical history who died suddenly after presenting with nausea. Postmortem examination revealed a significant infiltration of lymphocytes predominantly on the adventitia and periadventitial tissues of the coronary arteries in the epicardium. The lymphocytic infiltrate partially extended to the thickened intima with fibrosis, destructing the media and internal elastic lamina, and the lumen was occluded by a thrombus in the left main stem and left anterior descending branch. The arterial walls exhibited focal fibrinoid necrosis with regression in the intima and fibrous scars with angiogenesis in the media and adventitia. Focal myocardial infarction was detected in the left ventricle as a fibrotic change of the myocardium. No findings associated with vasculitis were discerned in the aorta, other peripheral arteries, or major organs. Laboratory tests of postmortem blood samples returned negative results for antinuclear antibodies, cryoglobulin, immunoglobulin G4, and cytoplasmic anti-neutrophil cytoplasmic antibodies for myeloperoxidase and proteinase 3. These autopsy findings suggest that the sudden death was caused by isolated necrotizing vasculitis that is assumed to be polyarteritis nodosa localized at the coronary arteries. However, pathological characteristics may not be exactly the same between isolated necrotizing vasculitis in the coronary arteries and polyarteritis nodosa.
Collapse
|
24
|
Systemic inflammatory activation in patients with acute coronary syndrome secondary to nonatherosclerotic spontaneous coronary artery dissection. North Clin Istanb 2019; 5:186-194. [PMID: 30688943 PMCID: PMC6323571 DOI: 10.14744/nci.2017.59244] [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: 06/06/2017] [Accepted: 09/20/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Pathological studies have suggested that local inflammation, particularly eosinophilic infiltration of the adventitia, could be related to nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD). However, the role of systemic inflammation in the pathogenesis of NA-SCAD remains unknown. Our aim was to investigate systemic inflammatory activation in patients with an acute coronary syndrome (ACS) secondary to NA-SCAD. METHODS The institutional electronic medical database was reviewed, and 22 patients with NA-SCAD-ACS were identified after the review. Furthermore, 30 random patients with CAD-ACS and 30 random subjects without any history of CAD or ACS with demographic and clinical characteristics similar to those of NA-SCAD-ACS patients were identified from the institutional database to be included in the study. RESULTS Patients with NA-SCAD-ACS and those with CAD-ACS both had higher white blood cell and neutrophil counts than controls. Neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels were only significantly higher in the NA-SCAD-ACS group [2.01 (1.54-6.17) for NLR and 0.70 (0.13-2.70) for CRP] than in the controls [1.55 (1.27-2.13), p=0.03 for NLR and 0.15 (0.10-0.43), p=0.049 for CRP]; however, there were no differences between the NA-SCAD-ACS and CAD-ACS groups [1.91 (1.41-2.78) for NLR and 0.41 (0.09-1.10) for CRP, p>0.05 for both comparisons] regarding all tested parameters. CONCLUSION The degree of inflammatory activation in NA-SCAD-ACS patients was similar to, or even greater than, that in CAD-ACS patients; thus, suggesting a role of inflammation in the pathophysiology of NA-SCAD-ACS.
Collapse
|
25
|
Eosinophilic inflammation in spontaneous coronary artery dissection: A potential therapeutic target? Med Hypotheses 2018; 121:91-94. [DOI: 10.1016/j.mehy.2018.09.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/06/2018] [Accepted: 09/22/2018] [Indexed: 12/16/2022]
|
26
|
Springer JM, Raveendran VV, Gierer SA, Maz M, Dileepan KN. Protective Role of Mast Cells in Primary Systemic Vasculitis: A Perspective. Front Immunol 2017; 8:990. [PMID: 28878769 PMCID: PMC5572344 DOI: 10.3389/fimmu.2017.00990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 08/03/2017] [Indexed: 01/02/2023] Open
Abstract
Mast cells are important cells of the immune system. Although traditionally considered as key players in allergic and hypersensitivity reactions, emerging evidence suggests that mast cells have many complex roles in vascular disease. These include regulation of vasodilation, angiogenesis, activation of matrix metalloproteinases, apoptosis of smooth muscle cells, and activation of the renin angiotensin system. Mast cells are also known to play an immunomodulatory role via modulation of regulatory T-cell (Treg), macrophage and endothelial cell functions. This dual role of the mast cells is evident in myeloperoxidase anti-neutrophil cytoplasmic antibodies-mouse model of glomerulonephritis in which mast cell deficiency worsens glomerulonephritis, whereas inhibition of mast cell degranulation is effective in abrogating the development of glomerulonephritis. Our previous work demonstrated that mast cell degranulation inhibits lipopolysaccharide-induced interleukin 6 (IL-6) production in mice. This effect was not seen in histamine-1-receptor knockout (H1R-/-) mice suggesting a role for histamine in IL-6 homeostasis. In addition, mast cell degranulation-mediated decrease in IL-6 production was associated with an upregulation of suppressor of cytokine signaling-1 protein in the aorta. We propose that mast cells regulate large artery inflammation through T-cells, shifting a primarily Th1 and Th17 toward a Th2 response and leading to enhanced IL-10 production, activation Treg cells, and the inhibition of macrophage functions.
Collapse
Affiliation(s)
- Jason M Springer
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Vineesh V Raveendran
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Selina A Gierer
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Mehrdad Maz
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kottarappat N Dileepan
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| |
Collapse
|
27
|
Abstract
Eosinophilic lung diseases especially comprise eosinophilic pneumonia or as the more transient Löffler syndrome, which is most often due to parasitic infections. The diagnosis of eosinophilic pneumonia is based on characteristic clinical-imaging features and the demonstration of alveolar eosinophilia, defined as at least 25% eosinophils at BAL. Peripheral blood eosinophilia is common but may be absent at presentation in idiopathic acute eosinophilic pneumonia, which may be misdiagnosed as severe infectious pneumonia. All possible causes of eosinophilia, including drug, toxin, fungus related etiologies, must be thoroughly investigated. Extrathoracic manifestations should raise the suspicion of eosinophilic granulomatosis with polyangiitis.
Collapse
|
28
|
A case of sudden cardiac death due to eosinophilic coronary periarteritis: possible significance of coexisting atherosclerosis and eosinophilic inflammation of the esophagus. Cardiovasc Pathol 2016; 25:67-71. [DOI: 10.1016/j.carpath.2015.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 12/27/2022] Open
|
29
|
Bhatt DD, Kachru R, Gupta S, Kaul U. Recurrent chest pain after treatment of spontaneous coronary artery dissection: An enigma. Indian Heart J 2015; 67 Suppl 3:S18-20. [PMID: 26995421 PMCID: PMC4799017 DOI: 10.1016/j.ihj.2015.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 08/24/2015] [Accepted: 09/04/2015] [Indexed: 11/30/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare entity. It has been described in various settings like pregnancy, collagen vascular diseases, cocaine abuse, heavy exercise, variant angina, eosinophilic arteritis, or fibro muscular dysplasia. It is also easy to miss a dissection during angiography, as the typical radiolucent lumen seen in coronary angiography may be absent in many cases. In this report, we describe the case of a 35-year-old female who presented with acute ST elevation myocardial infarction due to spontaneous coronary dissection. She had been having episodic chest pain for one year and had been seen by two different cardiologists but was thought to have non-cardiac symptoms. Even during the index hospitalization, she underwent coronary angiography three times before coronary dissection could be identified as the cause of her symptoms. She underwent coronary artery bypass graft surgery uneventfully. However, even after myocardial revascularization, she has had multiple episodes of chest pain requiring hospitalization. However, we have not been able to find a specific cause for it and the cause of her recurrent chest pain remains an enigma. This case highlights the problems, which arise while managing a case of SCAD. More research is needed to find the exact etiology and long-term prognosis of this condition.
Collapse
Affiliation(s)
- Dheeraj D Bhatt
- Fortis Rajan Dhall Hospital, Sector B, Pocket 1, Vasant Kunj, New Delhi 110070, India
| | - Ranjan Kachru
- Fortis Rajan Dhall Hospital, Sector B, Pocket 1, Vasant Kunj, New Delhi 110070, India
| | - Sanjay Gupta
- Fortis Rajan Dhall Hospital, Sector B, Pocket 1, Vasant Kunj, New Delhi 110070, India
| | - Upendra Kaul
- Executive Director and Dean, Fortis Rajan Dhall Hospital, Sector B, Pocket 1, Vasant Kunj, New Delhi 110070, India.
| |
Collapse
|
30
|
Allergy in extremis: a case of sudden unexpected death due to an allergy-associated disease. Am J Forensic Med Pathol 2015; 35:163-9. [PMID: 24918954 DOI: 10.1097/paf.0000000000000099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Allergy-associated diseases have a multitude of confirmed or suspected etiologies and associations affecting organs and organ systems. The hyper-reactivity of the immune system in which the eosinophils are prominent plays a central role in organ-specific and systemic effects in these diseases. Patients may be plagued with nonspecific, episodic, or progressive signs and symptoms. Patients may also exhibit signs and symptoms that mimic more common conditions. Recognition of certain patterns of clinical signs and symptoms may lead to definitive clinical diagnosis and effective treatment, particularly of less common but potentially lethal disease entities. The lack of clinical recognition of these patterns, whether due to "red herring" historical information, lack of sign/symptom specificity, clinical presentation at early stage, or unfamiliarity with the constellation of disease presentation, may delay or preclude diagnosis and treatment. The forensic pathologist must also have an awareness of varied clinical presentations of diseases because these can provide us with direction toward the ultimate determination of cause and manner of death.The importance and contribution of the practice of forensic pathology are highlighted in the instance of sudden and unexpected death, whereby the previously unrecognized or unconfirmed disease entity that leads to the death is revealed via analysis of scene information, autopsy performance, and review of medical history and history of the most recent illness. Through this comprehensive approach, a greater understanding of the extent and potential lethality of disease with reiteration of the importance of early clinical diagnosis and treatment is reinforced. This benefits the medical community involved in diagnosis and treatment, clinicians and pathologists alike, with the ultimate goal of reduction of morbidity and mortality.Reported is a case of sudden unexpected death with historical, gross, and microscopic findings consistent with a multisystem, inflammatory, allergic disease entity.
Collapse
|
31
|
Uribe CE, Ramirez-Barrera JD, Rubio C, Gallegos C, Ocampo LA, Saldarriaga C, Eusse C, Tenorio C, Lopez N, Moreno A, Jaramillo NG, Chehrazi-Raffle AM, Singh V, Martinez-Clark P. Spontaneous coronary artery dissection: Case series from two institutions with literature review. Anatol J Cardiol 2015; 15:409-15. [PMID: 25993713 PMCID: PMC5779179 DOI: 10.5152/akd.2015.5851] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2015] [Indexed: 11/22/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Consequently, its presentation and optimal treatment are yet to be clearly defined. In the current literature, all case series report less than 50 patients, most of whom are either young peripartum women or women who have used oral contraceptives over long periods. All information in this study was compiled by the database service from two hospitals, the first one between 2003 and 2012 and the second one between 2007 and 2012, to include the clinical characteristics, angiography. and treatment approaches in the study population. The study population consisted in four women (50%) and four men (50%) whose ages ranged between 28 and 57 years. Two women had a history of oral contraceptive use and three women presented during peripartum. None of the patients had traditional cardiovascular risk factors or previous heart disease. In 88% of the cases, the principal diagnoses were non-ST segment elevation myocardial infarction and unstable angina. All patients underwent emergency coronary angiography and percutaneous coronary intervention. Half of them were treated with drug-eluting stents and the other half with bare metal stents. The most frequent type of dissection was NIHBL Type E, and the right coronary artery was the most frequently compromised. SCAD is a rare cause of ACS; however, its identification has improved due to the availability of angiography and new complementary techniques. Regarding treatment, PCI seems effective with adequate long-term results.
Collapse
Affiliation(s)
| | | | - Carlos Rubio
- Clínica Cardio VID, Interventional Cardiology, Medellin, Colombia-USA
| | | | | | | | - Carlos Eusse
- Clínica Cardio VID, Interventional Cardiology, Medellin, Colombia-USA
| | - Carlos Tenorio
- Clínica Cardio VID, Interventional Cardiology, Medellin, Colombia-USA
| | - Nilson Lopez
- Hospital Pablo Tobon Uribe Cardiology; Medellin Colombia-USA
| | - Andres Moreno
- Clínica Cardio VID, Interventional Cardiology, Medellin, Colombia-USA
| | | | | | | | | |
Collapse
|
32
|
Eosinophilic cardiac disease: Molecular, clinical and imaging aspects. Arch Cardiovasc Dis 2015; 108:258-68. [DOI: 10.1016/j.acvd.2015.01.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 01/21/2023]
|
33
|
Mandal R, Brooks EG, Corliss RF. Eosinophilic Coronary Periarteritis with Arterial Dissection: The Mast Cell Hypothesis. J Forensic Sci 2015; 60:1088-92. [PMID: 25771824 DOI: 10.1111/1556-4029.12752] [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: 03/28/2014] [Revised: 06/25/2014] [Accepted: 07/09/2014] [Indexed: 01/21/2023]
Abstract
A subset of coronary arterial dissections is associated with eosinophilic coronary periarteritis (ECPA); however, the pathogenesis of the process remains unclear. Mast cells normally reside in coronary arterial adventitia and are known mediators of eosinophilic inflammatory conditions such as type I hypersensitivity reactions. We report two cases in which coronary arterial dissection with ECPA was detected at autopsy. Tryptase, CD68, CD4, CD8, and CD1a immunohistochemical staining was performed to better characterize inflammation. While eosinophils represented a prominent periadventitial inflammatory cell, there were slightly more lymphocytes: CD4/CD8 ratios were within expected reference ranges. There were moderate numbers of macrophages, and few neutrophils or dendritic cells. Numbers of mast cells in dissected versus nondissected sections were compared: adventitial mast cell densities were threefold higher in dissected portions and showed a trend toward increased degranulation. These findings suggest that mast cells may play a role in orchestrating inflammation in cases of ECPA.
Collapse
Affiliation(s)
- Rakesh Mandal
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 1111 Highland Avenue, Madison, WI, 53705
| | - Erin G Brooks
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 1111 Highland Avenue, Madison, WI, 53705
| | - Robert F Corliss
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 1111 Highland Avenue, Madison, WI, 53705
| |
Collapse
|
34
|
Cottin V, Cordier JF. Eosinophilic Pneumonia. ORPHAN LUNG DISEASES 2015. [PMCID: PMC7121898 DOI: 10.1007/978-1-4471-2401-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Eosinophilic pneumonia may manifest as chronic or transient infiltrates with mild symptoms, chronic idiopathic eosinophilic pneumonia, or the frequently severe acute eosinophilic pneumonia that may be secondary to a variety of causes (drug intake, new onset of tobacco smoking, infection) and that may necessitate mechanical ventilation. When present, blood eosinophilia greater than 1 × 109 eosinophils/L (and preferably greater than 1.5 × 109/L) is of considerable help for suggesting the diagnosis, however it may be absent, as in the early phase of idiopathic acute eosinophilic pneumonia or when patients are already taking corticosteroids. On bronchoalveolar lavage, high eosinophilia (>25 %, and preferably >40 % of differential cell count) is considered diagnostic of eosinophilic pneumonia in a compatible setting, obviating the need of video-assisted thoracic surgical lung biopsy, which is now performed only on very rare occasions with inconsistency between clinical, biological, and imaging features. Inquiry as to drug intake must be meticulous (www.pneumotox.com) and any suspected drug should be withdrawn. Laboratory investigations for parasitic causes must take into account the travel history or residence and the epidemiology of parasites. In patients with associated extrathoracic manifestations, the diagnosis of eosinophilic granulomatosis with polyangiitis or of the hypereosinophilic syndromes should be raised. Presence of airflow obstruction can be found in hypereosinophilic asthma, allergic bronchopulmonary aspergillosis, idiopathic chronic eosinophilic pneumonia, eosinophilic granulomatosis with polyangiitis, or in the recently identified syndrome of hyperosinophilic obliterative bronchiolitis. Corticosteroids remain the cornerstone of symptomatic treatment for eosinophilic pneumonias, with a generally dramatic response. Relapses are common when tapering the doses or after stopping treatment especially in idiopathic chronic eosinophilic pneumonia. Cyclophosphamide is necessary only in patients with eosinophilic granulomatosis with polyangiitis and poor-prognostic factors. Imatinib is very effective in the treatment of the myeloproliferative variant of hypereosinophilic syndromes. Anti-interleukin-5 monoclonal antibodies are promising in the spectrum of eosinophilic disorders.
Collapse
|
35
|
Michaud K, Grabherr S, Shiferaw K, Doenz F, Augsburger M, Mangin P. Acute coronary syndrome after levamisole-adultered cocaine abuse. J Forensic Leg Med 2014; 21:48-52. [DOI: 10.1016/j.jflm.2013.10.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/28/2013] [Accepted: 10/27/2013] [Indexed: 12/17/2022]
|
36
|
Kajihara H. Letter to Dr. Kounis. Virchows Arch 2013; 462:689-90. [DOI: 10.1007/s00428-013-1420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 04/26/2013] [Indexed: 11/30/2022]
|
37
|
Kounis NG, Mazarakis A, Tsigkas G. Eosinophilic coronary periarteritis presenting with vasospastic angina and sudden death: a new cause and manifestation of Kounis syndrome? Virchows Arch 2013; 462:687-8. [DOI: 10.1007/s00428-013-1406-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/25/2013] [Indexed: 10/27/2022]
|