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Coronary Artery Abnormalities as the Cause of Sudden Cardiac Death: A 20-Year Review. Am J Forensic Med Pathol 2018; 39:114-118. [PMID: 29461269 DOI: 10.1097/paf.0000000000000387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In this case series, we delve into the database of medicolegal cases of the Forensic Pathology Department at Hamilton Health Sciences in Hamilton Ontario from the last 20 years (1996-2017), and review cases of sudden cardiac death due to coronary artery abnormalities. We found 17 cases that fit the criteria, which gave us an incidence of 1.34 per 1000 cases. These cases were further audited for age, sex, type of coronary artery abnormality, symptoms before demise, circumstances of death, presence of significant atherosclerotic disease, and toxicology. Two more recent cases underwent postmortem genetic testing, and we reported on the result of one of these molecular studies. In our case series, the most commonly affected coronary artery was the right coronary artery, with the most common anomaly being abnormal origin from the left sinus of Valsalva. Although the literature maintains that left coronary artery from the opposite sinus is associated with higher incidence of SCD, our study shows that RCAs from the opposite aortic sinus, including those deemed to be low risk by classification, can be causes of SCD.
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Havakuk O, Goland S, Mehra A, Elkayam U. Pregnancy and the Risk of Spontaneous Coronary Artery Dissection: An Analysis of 120 Contemporary Cases. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.004941. [PMID: 28302642 DOI: 10.1161/circinterventions.117.004941] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because of the rarity of this condition, information on pregnancy-associated spontaneous coronary artery dissection is limited. We reviewed a large number of contemporary pregnancy-associated spontaneous coronary artery dissection cases in an attempt to define the clinical characteristics and provide management recommendations. METHODS AND RESULTS A literature search for cases of pregnancy-associated spontaneous coronary artery dissection reported between 2000 and 2015 included 120 cases; 75% presented with ST-segment-elevation myocardial infarction, and 80% had anterior myocardial infarction. Left anterior descending coronary artery was involved in 72% of cases, left main segment in 36%, and 40% had multivessel spontaneous coronary artery dissection. Ejection fraction was reduced to <40% in 44% of cases. Percutaneous coronary intervention was successful in only 50% of cases. Coronary artery bypass surgery was performed in 44 cases because of complex anatomy, hemodynamic instability, or failed percutaneous coronary intervention. Maternal complications included cardiogenic shock (24%), mechanical support (28%), urgent percutaneous coronary intervention (28%), urgent coronary artery bypass surgery (27.5%), maternal mortality (4%), and fetal mortality (2.5%). During follow-up for 305±111 days, there was a high incidence of symptoms because of persistent or new spontaneous coronary artery dissections, and 5 women needed heart transplantation or ventricular assist device implantation. CONCLUSIONS Pregnancy-associated spontaneous coronary artery dissection is commonly associated with left anterior descending, left main, and multivessel involvement, which leads to a high incidence of reduced ejection fraction, and life-threatening maternal and fetal complications. Percutaneous coronary intervention is associated with low success rate and high likelihood of complications, and coronary artery bypass surgery is often required. Recurrent ischemic events because of persistent or new spontaneous coronary artery dissection are common during long-term follow-up.
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Affiliation(s)
- Ofer Havakuk
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Sorel Goland
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Anil Mehra
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Uri Elkayam
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles.
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Tsutsui H, Chino C, Komatsu M, Sakai T, Aizawa K, Owa M. Resolution of spontaneous coronary artery dissection within 3 weeks detected by computed tomography angiography and intravascular ultrasound. Cardiovasc Interv Ther 2015; 32:77-81. [PMID: 26700028 DOI: 10.1007/s12928-015-0373-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
A 62-year-old woman was admitted with chest pain lasting about 3 h. Spontaneous coronary artery dissection (SCAD) was detected in the left anterior descending artery (LAD) by intravascular ultrasound (IVUS). Sixteen days after onset, follow-up computed tomography angiography was performed and revealed shrinkage of the false lumen of the SCAD. On hospital day 22, IVUS image confirmed that the SCAD in the LAD was completely healed. This case shows the possibility of rapid healing of SCAD.
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Affiliation(s)
- Hiroshi Tsutsui
- The Department of Cardiovascular Medicine, Japanese Red Cross Society Suwa Hospital, 5-11-50 Kogandori, Suwa City, Nagano, 392-8510, Japan.
| | - Chiharu Chino
- The Department of Cardiovascular Medicine, Japanese Red Cross Society Suwa Hospital, 5-11-50 Kogandori, Suwa City, Nagano, 392-8510, Japan
| | - Miho Komatsu
- The Department of Cardiovascular Medicine, Japanese Red Cross Society Suwa Hospital, 5-11-50 Kogandori, Suwa City, Nagano, 392-8510, Japan
| | - Takahiro Sakai
- The Department of Cardiovascular Medicine, Japanese Red Cross Society Suwa Hospital, 5-11-50 Kogandori, Suwa City, Nagano, 392-8510, Japan
| | - Kazunori Aizawa
- The Department of Cardiovascular Medicine, Japanese Red Cross Society Suwa Hospital, 5-11-50 Kogandori, Suwa City, Nagano, 392-8510, Japan
| | - Mafumi Owa
- The Department of Cardiovascular Medicine, Japanese Red Cross Society Suwa Hospital, 5-11-50 Kogandori, Suwa City, Nagano, 392-8510, Japan
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Spontaneous coronary artery dissection. Int J Cardiol 2014; 175:8-20. [DOI: 10.1016/j.ijcard.2014.04.178] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 02/19/2014] [Accepted: 04/17/2014] [Indexed: 02/03/2023]
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Elkayam U, Jalnapurkar S, Barakkat MN, Khatri N, Kealey AJ, Mehra A, Roth A. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Circulation 2014; 129:1695-702. [PMID: 24753549 DOI: 10.1161/circulationaha.113.002054] [Citation(s) in RCA: 264] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Uri Elkayam
- Department of Medicine, Division of Cardiovascular Diseases and the Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles (U.E., S.J., M.N.B., N.K., A.M.); Department of Cardiac Sciences, Foothills Medical Centre University of Calgary, Calgary, AB, Canada (A.J.K.); and Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel (A.R.)
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Fryearson J, Adamson DL. Heart disease in pregnancy: Ischaemic heart disease. Best Pract Res Clin Obstet Gynaecol 2014; 28:551-62. [DOI: 10.1016/j.bpobgyn.2014.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/20/2014] [Accepted: 03/26/2014] [Indexed: 12/20/2022]
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Jinnouchi H, Sakakura K, Matsuda J, Wakabayashi Y, Wada H, Momomura SI, Ako J. Recurrent spontaneous coronary artery dissection observed with multiple imaging modalities. Int Heart J 2013; 54:181-3. [PMID: 23774244 DOI: 10.1536/ihj.54.181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is considered to be a rare cause of acute coronary syndrome, especially recurrent or multivessel dissection. We present here the case of 51 year-old man who had recurrent and multivessel SCAD. In the initial event, the distal segment of the right coronary artery was spontaneously dissected, which was confirmed by coronary angiography (CAG), intracoronary ultrasound (IVUS), and multidetector computed tomography (MDCT). In the second event, the left coronary artery was spontaneously dissected. The dissection was confirmed by IVUS and MDCT, although CAG did not show stenosis, occlusion, or dissection in the left coronary artery. These findings suggest the weakness of CAG and the usefulness of IVUS or MDCT for the diagnosis of SCAD.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
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Nakashima T, Noguchi T, Morita Y, Sakamoto H, Goto Y, Ishihara M, Ogawa H, Yasuda S. Detection of intramural hematoma and serial non-contrast T1-weighted magnetic resonance imaging findings in a female patient with spontaneous coronary artery dissection. Circ J 2013; 77:2844-5. [PMID: 23842095 DOI: 10.1253/circj.cj-13-0539] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takahiro Nakashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Sheikh AS, O’Sullivan M. Pregnancy-related Spontaneous Coronary Artery Dissection: Two Case Reports and a Comprehensive Review of Literature. Heart Views 2012; 13:53-65. [PMID: 22919449 PMCID: PMC3424780 DOI: 10.4103/1995-705x.99229] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, particularly seen in women during pregnancy or in the puerperium. It has a high acute phase mortality. The etiology is uncertain. Hormonal changes during pregnancy, hemodynamic stress and changes in the autoimmune status have been considered as possible etiological factors. A timely diagnosis and institution of appropriate treatment is important for a successful outcome. There is no consensus of opinion for optimal treatment. Conservative management, coronary artery bypass graft surgery, and percutaneous coronary intervention, all have been described in the literature as possible therapeutic options. Spontaneous coronary artery dissection should be considered as a differential in any young woman presenting with chest pain associated with pregnancy. We report two cases of pregnancy-associated spontaneous coronary artery dissection, both successfully managed, along with a comprehensive review of the previously published literature.
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Affiliation(s)
- Azeem S Sheikh
- Department of Cardiology, Southend University Hospital NHS Foundation Trust, Essex, UK
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Pillow MT, Nguyen NA, Kuo D. Cardiac arrest from postpartum spontaneous coronary artery dissection. West J Emerg Med 2011; 12:567-70. [PMID: 22224163 PMCID: PMC3236138 DOI: 10.5811/westjem.2011.4.2263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 04/12/2011] [Accepted: 04/15/2011] [Indexed: 11/21/2022] Open
Abstract
We present the case of a 32-year-old woman who presented to the emergency department with a witnessed cardiac arrest. She was otherwise healthy with no cardiac risk factors and had undergone an uneventful repeated cesarean section 3 days priorly. The patient underwent defibrillation, out of ventricular fibrillation to a perfusing sinus rhythm, and was taken to the catheterization laboratory where coronary angiography findings showed spontaneous dissection of the left anterior descending artery. The patient received a total of 6 stents during her hospital stay and was eventually discharged in good condition. Spontaneous coronary artery dissection is a rare entity with a predilection for pregnant or postpartum women. Early diagnosis and treatment are key for survival, and when identified early, mortality rate is reduced.
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Affiliation(s)
- Malford T Pillow
- Baylor College of Medicine, Section of Emergency Medicine, Houston, Texas
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Klein AJ, Hudson PA, Kim MS, Cleveland JC, Messenger JC. Spontaneous left main coronary artery dissection and the role of intravascular ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:981-988. [PMID: 20498472 DOI: 10.7863/jum.2010.29.6.981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Spontaneous left main coronary artery (LMCA) dissection is a rare event with an unknown incidence and high risk of sudden cardiac death. The diagnosis of LMCA dissection is often challenging given the limitations of 2-dimensional angiography. The 3-dimensional perspective of intravascular ultrasonography (IVUS) is often indispensable in confirming or excluding the diagnosis of spontaneous LMCA dissection. We report 2 cases of spontaneous LMCA dissection with unique angiographic presentations wherein IVUS was essential in defining the extent of LMCA involvement and facilitated the subsequent referral for emergent coronary artery bypass grafting. METHODS Two patients presented to our facility with acute coronary syndrome prompting coronary angiography, which was notable for an unusual angiographic appearance of the LMCA. Intravascular ultrasonography was performed in each case, revealing spontaneous LMCA dissection. RESULTS Intravascular ultrasonography permitted the prompt diagnosis and aided in definitive surgical intervention in our 2 cases of spontaneous LMCA dissection. CONCLUSIONS Intravascular ultrasonography is a useful adjunctive imaging modality in the diagnosis and management of spontaneous LMCA dissection.
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Affiliation(s)
- Andrew J Klein
- Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St Louis University School of Medicine, St Louis, Missouri, USA
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