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Yoshino T, Yunoki K, Miyahara K, Ida J, Oka T. An unusual case of two acute coronary syndrome episodes caused by allergic and non-allergic coronary artery dissection with potential coronary vasospasm association: a case report. Eur Heart J Case Rep 2024; 8:ytae288. [PMID: 38933366 PMCID: PMC11204922 DOI: 10.1093/ehjcr/ytae288] [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: 01/29/2024] [Revised: 03/15/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
Background Type I variant Kounis syndrome is characterized by coronary spasm following an allergic or anaphylactic reaction. Coronary spasm is also recognized as a contributing factor in spontaneous coronary artery dissection (SCAD). Case summary A 46-year-old woman presented to the emergency room with a chief complaint of chest discomfort following the ingestion of a steamed bun. A marked decrease in systolic blood pressure and a prominent rash on her forearms and groin suggested anaphylactic shock. Upon stabilization of vital signs, acute coronary syndrome (ACS) was suspected based on electrocardiogram findings and symptoms, prompting an emergency coronary angiography (CAG). The CAG revealed severe stenosis with coronary artery dissection in the right coronary artery (RCA), and a stent implantation was performed. Given the suspicion of type I variant Kounis syndrome, a spasm provocation test was performed, yielding a positive result. Six years later, she experienced chest discomfort while sleeping and was admitted to our emergency department. An electrocardiogram showed ST-segment elevation in leads II, III, and aVF. An emergency CAG identified a severely stenotic lesion with coronary artery dissection in the RCA, leading to a diagnosis of SCAD. Direct stenting was performed at the stenotic site. The patient was discharged following intensification of medication. Discussion This report describes a rare case of a middle-aged woman with two episodes of ACS caused by both allergic and non-allergic coronary artery dissection. These episodes suggest that a shared underlying coronary vasospasm in both conditions may be a common trigger for coronary artery dissection.
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Affiliation(s)
- Tomohiro Yoshino
- Department of Cardiology, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0841, Japan
| | - Kei Yunoki
- Department of Cardiology, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0841, Japan
| | - Katsunori Miyahara
- Department of Cardiology, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0841, Japan
| | - Jun Ida
- Department of Cardiology, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0841, Japan
| | - Takefumi Oka
- Department of Cardiology, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0841, Japan
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Hirose K, Kamei I, Tanabe T, Haraki T. Spontaneous Coronary Artery Dissection With Concomitant Coronary Vasospasm. JACC Case Rep 2024; 29:102281. [PMID: 38645285 PMCID: PMC11031678 DOI: 10.1016/j.jaccas.2024.102281] [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: 12/07/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 04/23/2024]
Abstract
We herein describe a case of acute myocardial infarction due to spontaneous coronary artery dissection complicated by vasospastic angina. Given the need for different clinical management strategies of these cardiac manifestations, clinicians should consider the possibility of concomitant vasospasm in cases of spontaneous coronary artery dissection.
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Affiliation(s)
- Kazutoshi Hirose
- Department of Cardiovascular Medicine, The Saitama Eastern Cardiovascular Hospital, Saitama, Japan
| | - Izaya Kamei
- Department of Cardiovascular Medicine, The Saitama Eastern Cardiovascular Hospital, Saitama, Japan
| | - Takahiro Tanabe
- Department of Cardiovascular Medicine, The Saitama Eastern Cardiovascular Hospital, Saitama, Japan
| | - Tatsuo Haraki
- Department of Cardiovascular Medicine, The Saitama Eastern Cardiovascular Hospital, Saitama, Japan
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Dang Q, Othman F, Sheahen B, Marschner S, Psaltis P, Al-Lamee RK, Szirt R, Chong J, Zaman S. Regional and temporal variations of spontaneous coronary artery dissection care according to consensus recommendations: a systematic review and meta-analysis. Open Heart 2023; 10:e002379. [PMID: 38056913 DOI: 10.1136/openhrt-2023-002379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/01/2023] [Indexed: 12/08/2023] Open
Abstract
AIM The first expert consensus documents on management of patients with spontaneous coronary artery dissection (SCAD) were published in 2018. Worldwide quality of care, as measured by adherence to these recommendations, has not been systematically reviewed. We aim to review the proportion of patients with SCAD receiving consensus recommendations globally, regionally and, determine differences in practice before and after 2018. METHODS AND RESULTS A systematic review was performed by searching four main databases (Medline, Embase, SCOPUS, CINAHL) from their inception to 16 June 2022. Studies were selected if they included patients with SCAD and reported at least one of the consensus document recommendations. 53 studies, n=8456 patients (mean 50.1 years, 90.6% female) were included. On random effects meta-analysis, 92.1% (95% CI 89.3 to 94.8) received at least one antiplatelet, 78.0% (CI 73.5 to 82.4) received beta-blockers, 58.7% (CI 52.3 to 65.1) received ACE inhibitors or aldosterone receptor blockers (ACEIs/ARBs), 54.4% (CI 45.4 to 63.5) were screened for fibromuscular dysplasia (FMD), and 70.2% (CI 60.8 to 79.5) were referred to cardiac rehabilitation. Except for cardiac rehabilitation referral and use of ACEIs/ARBs, there was significant heterogeneity in all other quality-of-care parameters, across geographical regions. No significant difference was observed in adherence to recommendations in studies published before and after 2018, except for lower cardiac rehabilitation referrals after 2018 (test of heterogeneity, p=0.012). CONCLUSION There are significant variations globally in the management of patients with SCAD, particularly in FMD screening. Raising awareness about consensus recommendations and further prospective evidence about their effect on outcomes may help improve the quality of care for these patients.
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Affiliation(s)
- Quan Dang
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Farrah Othman
- The University of Western Australia, Perth, Western Australia, Australia
- Department of Cardiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Brodie Sheahen
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Simone Marschner
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
| | - Peter Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Medical and Health Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | | | - Richard Szirt
- St George Hospital, Kogarah, New South Wales, Australia
| | - James Chong
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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Kokawa T, Yoneda K, Takahashi T, Kishi K. Coronary artery dissection after acetylcholine administration in the absence of vasospasm: a case report. Eur Heart J Case Rep 2023; 7:ytad203. [PMID: 37144235 PMCID: PMC10152897 DOI: 10.1093/ehjcr/ytad203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/25/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Tatsuya Kokawa
- Corresponding author. Tel: +81-88-532-2555, Fax: +81-88-532-6350,
| | - Kohei Yoneda
- Division of Cardiology, Tokushima Red Cross Hospital, 103 Irinokuchi, Komatsushima-cho, Komatsushima, Tokushima 773-8502, Japan
| | - Takefumi Takahashi
- Division of Cardiology, Tokushima Red Cross Hospital, 103 Irinokuchi, Komatsushima-cho, Komatsushima, Tokushima 773-8502, Japan
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Spontaneous coronary artery dissection: Overview of pathophysiology. Trends Cardiovasc Med 2021; 32:92-100. [PMID: 33453416 DOI: 10.1016/j.tcm.2021.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/16/2022]
Abstract
The growing use of imaging examinations has led to increased detection of spontaneous coronary artery dissection (SCAD) as a non-atherosclerotic cause of acute coronary syndrome (ACS). Since a greater awareness of pathophysiologic mechanisms has relevant implications in clinical practice, we aim to provide an update to current knowledge of SCAD pathophysiology. We discuss the most common conditions associated with SCAD, including predisposing factors and triggers, and focus on potential mechanisms leading to SCAD development. Furthermore, we report the main genetic research findings that have shed further light on SCAD pathophysiology. Finally, we summarize practical considerations in SCAD management based on pathophysiologic insights.
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Pak S, Asuka E, Postoev A. Spontaneous Coronary Artery Dissection in a Young Man. J Med Cases 2020; 11:185-188. [PMID: 34434394 PMCID: PMC8383648 DOI: 10.14740/jmc3490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 12/31/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an idiosyncratic phenomenon by which a spontaneous separation of the intimal and medial layer in the coronary artery occurs with intramural hemorrhage in the absence of trauma. This intramural hematoma, in turn, leads to compression and occlusion of the arterial lumen. Unlike traumatic dissection of coronary arteries, more than half of SCAD heals spontaneously over time. SCAD is known to occur predominantly in women under the age of 50, particularly during pregnancy or peripartum period. Herein, we present a case of a 32-year-old man with an SCAD on the left anterior descending coronary artery. The discordance between clinical presentation and angiographic finding posed a unique challenge in therapeutic decision making. This case reminds clinicians that SCAD should be kept in mind as a differential diagnosis even for young men presenting with acute chest pain.
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Affiliation(s)
- Stella Pak
- Department of Medicine, Orange Regional Medical Center, Middletown, NY, USA
| | - Edinen Asuka
- All Saints University School of Medicine, Roseau, Dominica
| | - Anastasia Postoev
- Department of Medicine, Caribbean Medical University, 5600 N River Rd, Rosemont, IL 60018, USA
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Kumar TR, Reusch JEB, Kohrt WM, Regensteiner JG. Sex Differences Across the Lifespan: A Focus on Cardiometabolism. J Womens Health (Larchmt) 2020; 29:899-909. [PMID: 32423340 DOI: 10.1089/jwh.2020.8408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Women's health and sex differences research remain understudied. In 2016, to address the topic of sex differences, the Center for Women' s Health Research (CWHR) at the University of Colorado (cwhr@ucdenver.edu) held its inaugural National Conference, "Sex Differences Across the Lifespan: A Focus on Metabolism" and published a report summarizing the presentations. Two years later, in 2018, CWHR organized the 2nd National Conference. The research presentations and discussions from the 2018 conference also addressed sex differences across the lifespan with a focus on cardiometabolism and expanded the focus by including circadian physiology and effects of sleep on cardiometabolic health. Over 100 participants, including basic scientists, clinicians, policymakers, advocacy group leaders, and federal agency leadership participated. The meeting proceedings reveal that although exciting advances in the area of sex differences have taken place, significant questions and gaps remain about women's health and sex differences in critical areas of health. Identifying these gaps and the subsequent research that will result may lead to important breakthroughs.
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Affiliation(s)
- T Rajendra Kumar
- Department of Obstetrics and Gynecology and University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jane E B Reusch
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Veterans Administration Eastern Colorado Health Care System, Denver, Colorado, USA
| | - Wendy M Kohrt
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Judith G Regensteiner
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Waterbury TM, Tarantini G, Vogel B, Mehran R, Gersh BJ, Gulati R. Non-atherosclerotic causes of acute coronary syndromes. Nat Rev Cardiol 2019; 17:229-241. [DOI: 10.1038/s41569-019-0273-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2019] [Indexed: 12/15/2022]
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Abstract
Introduction: Spontaneous coronary artery dissection (SCAD) is an increasingly appreciated cause of acute myocardial infarction (AMI) and sudden cardiac death most often affecting young to middle-aged women with few conventional cardiovascular risk factors. Areas covered: A literature search was performed using MedLine, PubMed, and Google Scholar (dating to 04/30/2019). Authors review the key clinical features of SCAD and highlight what is known regarding its pathophysiology and associated factors. The relationship between SCAD and other systemic vasculopathies, notably fibromuscular dysplasia (FMD) is also discussed. Authors also mention the management of acute SCAD along with considerations for long term follow-up such as chest pain syndrome, extracoronary vasculopathy screening, and recurrent SCAD. Expert opinion: Our understanding regarding the association of SCAD and other arteriopathies such as FMD is anticipated to grow. In addition, progress is likely to be made in our efforts to predict recurrent SCAD risk and define potential preventative strategies, possibly through the incorporation of adjunctive imaging.
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Affiliation(s)
- Nicholas Y Tan
- a Department of Cardiovascular Diseases , Mayo Clinic , Rochester , MN , USA
| | - Marysia S Tweet
- a Department of Cardiovascular Diseases , Mayo Clinic , Rochester , MN , USA
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