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Cosma J, Russo A, Ferradini V, Gobbi C, Mallia V, Zuffi A, Joret C, Sacca S, Mango R. Spontaneous coronary artery dissection: review, case report and analysis of COVID-19-related cases. Minerva Cardiol Angiol 2024; 72:251-265. [PMID: 36847436 DOI: 10.23736/s2724-5683.22.06195-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) accounts for 1-4% of all acute coronary syndromes (ACS). Since the first description in 1931, our understanding of the disease has evolved; however, its pathophysiology and management are still a matter of debate. SCAD typically occurs in a middle-aged woman with no or few traditional cardiovascular risk factors. Two hypotheses have been proposed to explain the pathophysiology depending on the primary event: an intimal tear in the "inside-out" hypothesis and a spontaneous hemorrhage from the vasa vasorum in the "outside-in" hypothesis. Etiology appears to be multifactorial: different predisposing and precipitating factors have been identified. Coronary angiography is the gold standard for the diagnosis of SCAD. Current recommendations on the treatment of SCAD patients are based on expert opinions: a conservative strategy is preferred in hemodynamically stable SCAD patients, while urgent revascularization should be considered in hemodynamically unstable patients. Eleven cases of SCAD in COVID-19 patients have already been described: although the exact pathophysiological mechanism remains unclear, COVID-19-related SCAD is considered a combination of significant systemic inflammatory response and localized vascular inflammation. We present a literature review of SCAD, and we report an unpublished case of SCAD in a COVID-19 patient.
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Affiliation(s)
- Joseph Cosma
- Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France -
| | - Alessandro Russo
- Department of Cardiology, Ospedale Civile di Mirano, Mirano, Venice, Italy
| | - Valentina Ferradini
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Cecilia Gobbi
- Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France
| | - Vincenzo Mallia
- Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France
| | - Andrea Zuffi
- Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France
| | - Cédric Joret
- Cardiovascular Institute of Caen, Saint Martin Private Hospital, Caen, France
| | - Salvatore Sacca
- Department of Cardiology, Ospedale Civile di Mirano, Mirano, Venice, Italy
| | - Ruggiero Mango
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
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2
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Krljanac G, Apostolovic S, Polovina M, Maksimovic R, Nedeljkovic Arsenovic O, Djordjevic N, Stankovic S, Savic L, Djokovic A, Viduljevic M, Stankovic S, Asanin M. The follow-up of myocardial injury and left ventricular function after spontaneous coronary artery dissection. Front Cardiovasc Med 2023; 10:1276347. [PMID: 38034376 PMCID: PMC10682093 DOI: 10.3389/fcvm.2023.1276347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023] Open
Abstract
Monitoring patients with spontaneous coronary dissection (SCAD) is critical in their care, as there are no accepted recommendations. To this end, finding clinical or imaging predictors of recurrent events in these patients is essential for predicting adverse events and guiding treatment decisions between conservative medical therapy and percutaneous coronary intervention. Myocardial injury and left ventricular function after SCAD can be variable parameters that require monitoring. Echocardiography and cardiac magnetic resonance are two useful imaging techniques to do so. This review aims to analyze previously published results on monitoring myocardial injury and left ventricular function in SCAD patients while highlighting the potential benefits of contemporary imaging techniques that could further improve patient care in the future.
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Affiliation(s)
- Gordana Krljanac
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Svetlana Apostolovic
- Coronary Care Unit, Cardiology Clinic, University Clinical Center of Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
| | - Marija Polovina
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ruzica Maksimovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | - Olga Nedeljkovic Arsenovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nemanja Djordjevic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Stefan Stankovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Lidija Savic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Djokovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Mihajlo Viduljevic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Milika Asanin
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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3
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Acute myocardial infarction complicated with takotsubo syndrome in an elderly patient: case report and literature review. J Geriatr Cardiol 2022; 19:473-480. [PMID: 35845159 PMCID: PMC9248273 DOI: 10.11909/j.issn.1671-5411.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Shojaei F, Habibi Z, Goudarzi S, Firouzabadi FD, Montazerin SM, Najafi H, Kahe F, Momenzadeh K, Mir M, Khan F, Jamil U, Jamil A, Lee JJ, Chi G. COVID-19: A double threat to takotsubo cardiomyopathy and spontaneous coronary artery dissection? Med Hypotheses 2020; 146:110410. [PMID: 33267999 PMCID: PMC7680528 DOI: 10.1016/j.mehy.2020.110410] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an ongoing pandemic that has affected millions of individuals worldwide. Prior studies suggest that COVID-19 may be associated with an increased risk for various cardiovascular disorders, such as myocardial injury, arrhythmia, acute coronary syndrome, and venous thromboembolism. Early reports of non-COVID-19 patients have described the concurrence of takotsubo cardiomyopathy (TTC) and spontaneous coronary artery dissection (SCAD). However, the interplay between COVID-19, TTC and SCAD has not been well established. We herein propose two sets of two-hit hypotheses for the development of SCAD and TTC in the context of COVID-19. The first two-hit hypothesis explains the development of SCAD, in which TTC-associated formation of vulnerable coronary substrate serves as the first hit (predisposing factor), and COVID-19-associated inflammation and vascular disruption serves as the second hit (precipitating factor). The second two-hit hypothesis is proposed to explain the development of TTC, in which SCAD-associated formation of vulnerable myocardial substrate serves as the first hit, and COVID-19-associated sympathetic overactivity serves as the second hit. Under this conceptual framework, COVID-19 poses a double threat for the development of SCAD (among patients with underlying TTC) as well as TTC (among patients with underlying SCAD), thereby forming a reciprocal causation. This hypothesis provides a rationale for the joint assessment of TTC and SCAD in COVID-19 patients with pertinent cardiovascular manifestations.
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Affiliation(s)
- Fahimehalsadat Shojaei
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Zahra Habibi
- Global Studies Institute, Université de Genève, Geneva, Switzerland
| | - Sogand Goudarzi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fatemeh Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Memar Montazerin
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Homa Najafi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Farima Kahe
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kaveh Momenzadeh
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Mahshid Mir
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Faris Khan
- Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Umer Jamil
- Department of Medicine, OSF Healthcare, St. Francis Medical Center, Peoria, IL, USA
| | - Adeel Jamil
- Department of Medicine, OSF Healthcare, St. Francis Medical Center, Peoria, IL, USA
| | - Jane J Lee
- Baim Institute for Clinical Research, Boston, MA, USA
| | - Gerald Chi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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5
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Sakatani A, Kume K, Nishio M, Hirooka K, Hayashi T. Takotsubo syndrome triggered by coronary artery embolism in a patient with chronic atrial fibrillation. J Cardiol Cases 2020; 22:45-47. [PMID: 32774517 PMCID: PMC7403553 DOI: 10.1016/j.jccase.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/06/2020] [Accepted: 01/11/2020] [Indexed: 11/30/2022] Open
Abstract
Although takotsubo syndrome is defined as a reversible heart failure syndrome with the absence of obstructive coronary artery disease, some cases of concomitant takotsubo syndrome and acute myocardial infarction have been reported. We herein describe the case of a patient with chronic nonvalvular atrial fibrillation who was not receiving anticoagulant therapy, who developed takotsubo syndrome triggered by acute myocardial infarction probably due to coronary artery thromboembolism. <Learning objective: Takotsubo syndrome triggered by acute myocardial infarction rarely occurs. Patients with a broad infarct-area require careful management because of the development of adverse events such as cardiogenic shock.>
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Affiliation(s)
| | - Kiyoshi Kume
- Corresponding author at: Cardiovascular Division, Osaka Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka 565-0862, Japan.
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Hausvater A, Smilowitz NR, Saw J, Sherrid M, Ali T, Espinosa D, Mersha R, DeFonte M, Reynolds HR. Spontaneous Coronary Artery Dissection in Patients With a Provisional Diagnosis of Takotsubo Syndrome. J Am Heart Assoc 2019; 8:e013581. [PMID: 31711381 PMCID: PMC6915268 DOI: 10.1161/jaha.119.013581] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/24/2019] [Indexed: 01/18/2023]
Abstract
Background Takotsubo syndrome (TTS) mimics acute myocardial infarction in the absence of culprit coronary artery disease and is more common in women. Spontaneous coronary artery dissection (SCAD) shares a predilection for women, can result in left ventricular wall motion abnormalities similar to TTS, and may manifest subtle angiographic findings. The aim of this study was to determine the frequency of SCAD misdiagnosed as TTS. Methods and Results Coronary angiograms of patients presenting with a provisional diagnosis of TTS were retrospectively reviewed by an independent expert blinded to left ventriculography and the specific purpose of the study to assess for SCAD. TTS was defined using European Society for Cardiology criteria. SCAD was categorized according to the Saw angiographic classification. Among 80 women with a provisional diagnosis of TTS, 2 (2.5%) met angiographic criteria for definite SCAD. Both dissections were located in the distal left anterior descending coronary artery and classified as type 2b. The wall motion abnormality was apical in both cases. An additional 7 patients (9%) had angiography that was indeterminate for SCAD. Clinical characteristics of patients with and without SCAD were similar. Conclusions Among patients with a provisional diagnosis of TTS, definite SCAD in the left anterior descending coronary artery was present in 2.5% of cases, and coronary angiography was indeterminate for SCAD in an additional 9%. Careful review of coronary angiography may avoid missed diagnoses of SCAD in patients with myocardial infarction, nonobstructive coronary arteries, and wall motion abnormalities consistent with TTS. Intracoronary imaging maybe considered to establish a definitive diagnosis of SCAD when angiography is inconclusive.
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Affiliation(s)
- Anaïs Hausvater
- Soter Center for Women's Cardiovascular ResearchLeon H. Charney Division of CardiologyDepartment of MedicineNew York University School of MedicineNew YorkNY
| | - Nathaniel R. Smilowitz
- Soter Center for Women's Cardiovascular ResearchLeon H. Charney Division of CardiologyDepartment of MedicineNew York University School of MedicineNew YorkNY
| | - Jacqueline Saw
- Division of CardiologyVancouver General HospitalVancouverBCCanada
| | - Mark Sherrid
- Soter Center for Women's Cardiovascular ResearchLeon H. Charney Division of CardiologyDepartment of MedicineNew York University School of MedicineNew YorkNY
| | - Thara Ali
- Soter Center for Women's Cardiovascular ResearchLeon H. Charney Division of CardiologyDepartment of MedicineNew York University School of MedicineNew YorkNY
| | - Dalisa Espinosa
- Soter Center for Women's Cardiovascular ResearchLeon H. Charney Division of CardiologyDepartment of MedicineNew York University School of MedicineNew YorkNY
| | - Rediet Mersha
- Soter Center for Women's Cardiovascular ResearchLeon H. Charney Division of CardiologyDepartment of MedicineNew York University School of MedicineNew YorkNY
| | - Maria DeFonte
- Soter Center for Women's Cardiovascular ResearchLeon H. Charney Division of CardiologyDepartment of MedicineNew York University School of MedicineNew YorkNY
| | - Harmony R. Reynolds
- Soter Center for Women's Cardiovascular ResearchLeon H. Charney Division of CardiologyDepartment of MedicineNew York University School of MedicineNew YorkNY
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7
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Takotsubo Syndrome Associated with ST Elevation Myocardial Infarction. Case Rep Cardiol 2019; 2019:1010243. [PMID: 31223504 PMCID: PMC6541970 DOI: 10.1155/2019/1010243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/03/2019] [Accepted: 02/26/2019] [Indexed: 12/31/2022] Open
Abstract
Background Takotsubo syndrome is a reversible heart failure syndrome which often presents with symptoms and ECG changes that mimic an acute myocardial infarction. Obstructive coronary artery disease has traditionally been seen as exclusion criteria for the diagnosis of takotsubo; however, recent reports have called this into question and suggest that the two conditions may coexist. Case Summary We describe a case of an 83-year-old male presenting with chest pain consistent with acute myocardial infarction. The ECG demonstrated anterior ST elevation with bedside echocardiography showing apical wall motion abnormalities. Cardiac catheterisation found an occluded OM2 branch of the left circumflex artery with ventriculography confirming apical ballooning consistent with takotsubo and not in the vascular territory supplied by the occluded epicardial vessel. Repeat echocardiogram 6 weeks later confirmed resolution of the apical wall motion abnormalities consistent with a diagnosis of takotsubo. Discussion This case demonstrates the finding of takotsubo syndrome in a male patient with acute myocardial infarction. Traditionally, this would preclude a diagnosis of takotsubo; however, following previous reports of takotsubo in association with coronary artery dissection and acute myocardial infarction in female patients, new diagnostic criteria have been proposed which allow the diagnosis of takotsubo in the presence of obstructive coronary artery disease. This case adds to the growing body of literature that suggests takotsubo can coexist with acute myocardial infarction; however, it remains to be elucidated if it is a consequence or cause of myocardial infarction.
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8
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Spontaneous coronary artery dissection and its association with takotsubo syndrome: Novel insights from a tertiary center registry. Catheter Cardiovasc Interv 2019; 95:485-491. [DOI: 10.1002/ccd.28314] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/22/2019] [Accepted: 04/15/2019] [Indexed: 12/24/2022]
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Y-Hassan S, Henareh L. Fibrinolysis-treated myocardial infarction in a patient with missed spontaneous coronary artery dissection associated with takotsubo syndrome: case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 2:yty145. [PMID: 31020220 PMCID: PMC6426041 DOI: 10.1093/ehjcr/yty145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/11/2018] [Indexed: 01/30/2023]
Abstract
Background Spontaneous coronary artery dissection (SCAD) is an under-recognized acute cardiac disease entity. It is often missed, or misdiagnosed as coronary spasm, coronary atherosclerotic lesion, or thrombotic coronary occlusion. During the last years, SCAD also has been reported to be 'misdiagnosed as takotsubo syndrome (TS)' in patients with features consistent with both conditions. Spontaneous coronary artery dissection may present as an acute coronary syndrome and sometimes as sudden cardiac death. Case summary We report on the case of a 67-year-old woman who presented with features of ST-elevation myocardial infarction treated with fibrinolysis. The patient showed to have obtuse-marginal SCAD, which was misdiagnosed as fibrinolysis caused lysis of a coronary thrombus. The patient had moreover all other features of TS. Discussion This case report teaches important information about SCAD. The association between SCAD and TS are discussed.
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Affiliation(s)
- Shams Y-Hassan
- Coronary and Vascular Heart Disease, Heart and Vascular Theme, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Loghman Henareh
- Coronary and Vascular Heart Disease, Heart and Vascular Theme, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, Ganesh SK, Gulati R, Lindsay ME, Mieres JH, Naderi S, Shah S, Thaler DE, Tweet MS, Wood MJ. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e523-e557. [PMID: 29472380 PMCID: PMC5957087 DOI: 10.1161/cir.0000000000000564] [Citation(s) in RCA: 709] [Impact Index Per Article: 118.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.
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11
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Y-Hassan S. Myocardial Infarction in Patients with Takotsubo Syndrome: Trigger and Consequence. Am J Med 2018; 131:e217. [PMID: 29673495 DOI: 10.1016/j.amjmed.2017.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Shams Y-Hassan
- Department of Cardiology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden
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12
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Y-Hassan S. Spontaneous coronary artery dissection and takotsubo syndrome: An often overlooked association; review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:717-723. [PMID: 29502960 DOI: 10.1016/j.carrev.2018.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 12/30/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) and takotsubo syndrome (TS) are two cardiovascular syndromes with predilection for women. Both conditions may be preceded by an emotional stress or, for the affected individual, an unusual severe physical exercise. "Restitution ad integrum" occurs in most cases suffering from SCAD or TS with complete angiographic resolution of the dissected vessel and left ventricular dysfunction respectively. Recently, many cases, which were initially diagnosed as TS because of typical left ventricular ballooning pattern showed to have SCAD, have been reported; these cases were deemed to be "SCAD misdiagnosed as TS". The left ventricular wall motion abnormality has been attributed to the ischemia caused by SCAD-affected coronary vessel especially in the left anterior descending artery (LAD) with "wrap-around course". However, the left ventricular ballooning pattern have occurred in patients with SCAD in non-long-wrap-around LAD and SCAD in other coronary branches where coronary ischemia on its own cannot explain the left ventricular ballooning. In this review, sufficient data supporting the evidence for the possibility of coexistence of SCAD and TS is provided. Misdiagnosis of the association of the two conditions may result in mismanagement of the patient with undesirable consequences. Furthermore, the causal links between SCAD and TS is discussed.
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Affiliation(s)
- Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, Huddinge, S- 141 86, Stockholm, Sweden.
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13
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Madias JE. Could echocardiography determine whether spontaneous coronary dissection is occasionally associated with Takotsubo syndrome? Echocardiography 2018; 35:241-243. [DOI: 10.1111/echo.13804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- John E. Madias
- Icahn School of Medicine at Mount Sinai; New York NY USA
- Division of Cardiology; Elmhurst Hospital Center; Elmhurst NY USA
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14
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Buccheri D, Zambelli G. The link between spontaneous coronary artery dissection and takotsubo cardiomyopathy: analysis of the published cases. J Thorac Dis 2017; 9:5489-5492. [PMID: 29312758 DOI: 10.21037/jtd.2017.11.07] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) and takotsubo cardiomyopathy (TTS) are two non-atherosclerotic causes of myocardial infarction. They share several common features. Firstly, they have a predilection for the female gender and, in both, the exact mechanism has yet to be fully established. Both they could be responsible for an acute coronary syndrome. Hence, we want to do further consideration based on pathophysiology, literature review, and cases presented affected by both entities up today.
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Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giulia Zambelli
- Cardiology Department, Paolo Giaccone Hospital, Palermo, Italy
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15
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Y-Hassan S. Why do you not call the condition takotsubo syndrome triggered by acute coronary ischemia? Echocardiography 2017; 34:1552-1553. [DOI: 10.1111/echo.13703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Shams Y-Hassan
- Department of Cardiology; Karolinska Institute at Karolinska University Hospital; Huddinge Stockholm Sweden
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16
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Y-Hassan S, Tornvall P. Epidemiology, pathogenesis, and management of takotsubo syndrome. Clin Auton Res 2017; 28:53-65. [PMID: 28917022 PMCID: PMC5805795 DOI: 10.1007/s10286-017-0465-z] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/31/2017] [Indexed: 12/14/2022]
Abstract
Takotsubo syndrome is a recently recognized acute cardiac disease entity with a clinical presentation resembling that of an acute coronary syndrome. The typical takotsubo syndrome patient has a unique circumferential left (bi-) ventricular contraction abnormality profile that extends beyond a coronary artery supply territory and appears to follow the anatomical cardiac sympathetic innervation. The syndrome predominantly affects postmenopausal women and is often preceded by emotional or physical stress. Patients with predisposing factors such as malignancy and other chronic comorbidities are more prone to suffer from takotsubo syndrome. The pathogenesis of takotsubo syndrome is elusive. Several pathophysiological mechanisms involving myocardial ischemia (multivessel coronary artery spasm, microvascular dysfunction, aborted myocardial infarction), left ventricular outlet tract obstruction, blood-borne catecholamine myocardial toxicity, epinephrine-induced switch in signal trafficking, and autonomic nervous system dysfunction have been proposed. The syndrome is usually reversible; nevertheless, during the acute stage, a substantial number of patients develop severe complications such as arrhythmias, heart failure including pulmonary edema and cardiogenic shock, thromboembolism, cardiac arrest, and rupture. Treatment of precipitating factors, predisposing diseases, and complications is fundamental during the acute stage of the disease. The epidemiology, pathogenesis, and management of takotsubo syndrome are reviewed in this paper.
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Affiliation(s)
- Shams Y-Hassan
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital, Solna, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden.
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17
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Y-Hassan S, Themudo R, Maret E. Spontaneous coronary artery dissection and takotsubo syndrome: The chicken or the egg causality dilemma. Catheter Cardiovasc Interv 2017; 89:1215-1218. [DOI: 10.1002/ccd.26956] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/30/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Shams Y-Hassan
- Department of Cardiology; Karolinska Institutet, and Karolinska University Hospital; Stockholm Sweden
| | - Raquel Themudo
- Department of Radiology; Karolinska institutet, and Karolinska Unversity Hospital; Stockholm Sweden
| | - Eva Maret
- Department of Clinical Physiology; Karolinska institutet, and Karolinska Unversity Hospital; Stockholm Sweden
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18
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Spontaneous coronary artery dissection was missed but not misdiagnosed as takotsubo syndrome. Int J Cardiol 2017; 229:29. [DOI: 10.1016/j.ijcard.2016.11.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/18/2016] [Indexed: 11/17/2022]
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19
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Y-Hassan S, Böhm F. The causal link between spontaneous coronary artery dissection and takotsubo syndrome: A case presented with both conditions. Int J Cardiol 2015; 203:828-31. [PMID: 26599743 DOI: 10.1016/j.ijcard.2015.11.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 01/30/2023]
Affiliation(s)
- Shams Y-Hassan
- Karolinska Institute, Karolinska University Hospital, Department of Cardiology, Sweden.
| | - Felix Böhm
- Karolinska Institute, Karolinska University Hospital, Department of Cardiology, Sweden
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20
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Y-Hassan S. Post-ischemic myocardial stunning was the starting point of takotsubo syndrome: Restitution is justified after falling down on. Int J Cardiol 2015; 198:174-5. [DOI: 10.1016/j.ijcard.2015.06.113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/26/2015] [Indexed: 01/30/2023]
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21
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Y-Hassan S, Cederlund K, Mogensen B, Henareh L. Multiple and recurrent spontaneous coronary artery dissection: Angiographically visible and invisible dissections in the same patient. Int J Cardiol 2015; 197:140-3. [DOI: 10.1016/j.ijcard.2015.06.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/16/2015] [Indexed: 11/15/2022]
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22
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Yalta K, Ucar F, Yilmaztepe M, Ozkalayci F. Tako-tsubo cardiomyopathy and spontaneous coronary artery dissection: A subtle association with prognostic implications? Int J Cardiol 2015; 202:174-6. [PMID: 26397404 DOI: 10.1016/j.ijcard.2015.08.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Kenan Yalta
- Trakya University Cardiology Department, Edirne, Turkey.
| | - Fatih Ucar
- Trakya University Cardiology Department, Edirne, Turkey
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23
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Y-Hassan S. Takotsubo Syndrome in Patients With Spontaneous Coronary Artery Dissection: Misdiagnosis or a Reality? Can J Cardiol 2015; 31:1410.e3. [PMID: 26440508 DOI: 10.1016/j.cjca.2015.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022] Open
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24
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Treatment strategy of spontaneous coronary artery dissection: Conservative or interventional. Int J Cardiol 2015; 191:82-3. [DOI: 10.1016/j.ijcard.2015.04.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/21/2022]
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25
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Y-Hassan S. Acute coronary syndrome or takotsubo syndrome: Most probably both of them, the first has triggered the second. Int J Cardiol 2015; 190:367-8. [DOI: 10.1016/j.ijcard.2015.04.154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/18/2015] [Indexed: 12/21/2022]
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26
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Angiographically invisible spontaneous coronary artery dissection: A ticking time bomb during coronary intervention. Int J Cardiol 2015; 187:374-6. [DOI: 10.1016/j.ijcard.2015.03.244] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/17/2015] [Indexed: 11/21/2022]
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27
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Chou AY, Sedlak T, Aymong E, Sheth T, Starovoytov A, Humphries KH, Mancini GBJ, Saw J. Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Cardiomyopathy: A Case Series. Can J Cardiol 2015. [PMID: 26211710 DOI: 10.1016/j.cjca.2015.03.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) and Takotsubo cardiomyopathy (TTC) can both cause myocardial infarction with subsequent normalization of wall motion abnormality. Angiograms of patients with TTC at Vancouver General Hospital were reviewed for SCAD. Clinical and investigational characteristics were recorded. Nine women with nonatherosclerotic SCAD were misdiagnosed as having TTC. Their average age was 55 years. Five patients had hypertension and 4 had emotional or physical stress. Fibromuscular dysplasia was present in 4 women. Wall motion abnormalities corresponded to dissected artery location and subsequently resolved. SCAD should be included in the differential diagnosis of patients suspected of having TTC and coronary angiograms scrutinized for subtle SCAD.
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Affiliation(s)
- Annie Y Chou
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Sedlak
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eve Aymong
- Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tej Sheth
- Division of Cardiology, Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Starovoytov
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karin H Humphries
- Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - G B John Mancini
- 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.
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28
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Y-Hassan S. Cardiac rupture in a patient with Takotsubo syndrome triggered by acute myocardial infarction: Two messages. Int J Cardiol 2014; 177:162-5. [DOI: 10.1016/j.ijcard.2014.09.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/20/2014] [Indexed: 11/29/2022]
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29
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Pathophysiology of takotsubo syndrome: Acute cardiac sympathetic disruption (ACSD) syndrome. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:311-2. [DOI: 10.1016/j.carrev.2014.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 01/30/2023]
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30
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Y-Hassan S. The real-world prevalence of Takotsubo syndrome in patients with ST-elevation myocardial infarction: highly underestimated. Eur J Intern Med 2014; 25:e61-2. [PMID: 24565532 DOI: 10.1016/j.ejim.2014.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 01/27/2014] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Shams Y-Hassan
- Karolinska University Hospital, Huddinge, Department of Cardiology, S-141 86 Stockholm, Sweden.
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Y-Hassan S. Too many cooks spoil the broth: The currently existing diagnostic criteria for Takotsubo syndrome. Int J Cardiol 2014; 173:568-70. [DOI: 10.1016/j.ijcard.2014.03.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/14/2014] [Indexed: 01/09/2023]
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32
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Y-Hassan S. Acute cardiac sympathetic disruption in the pathogenesis of the takotsubo syndrome: a systematic review of the literature to date. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 15:35-42. [PMID: 24140050 DOI: 10.1016/j.carrev.2013.09.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 09/09/2013] [Accepted: 09/13/2013] [Indexed: 12/25/2022]
Abstract
Takotsubo syndrome (TS), also known as broken heart syndrome and neurogenic stunned myocardium, is an acute cardiac disease entity characterized by a clinical picture mimicking that of an acute coronary syndrome. The pathogenesis of TS has not been established yet. Among the most often debated pathologic mechanisms of TS are as follows: first, multi-vessel coronary spasm; second, myocardial microvascular dysfunction; third, aborted myocardial infarction caused by transient thrombotic occlusion of a long wrap-around left anterior descending artery; fourth, left ventricular outflow tract obstruction; fifth, blood-borne catecholamine cardiac toxicity; and sixth, cardiac sympathetic disruption and norepinephrine seethe and spillover. The aim of this review is to provide a thorough analysis of the literature data coming mainly from the neurological literature and dealing with the pathogenesis of TS. Substantial evidence challenging the first five hypotheses and arguing in favor of the hypothesis that acute cardiac sympathetic eruption and norepinephrine seethe and spillover is causing TS in predisposed patients is presented.
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Affiliation(s)
- Shams Y-Hassan
- Department of Cardiology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden.
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