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Marraki ZE, Mounaouir K, Marcolet P, Halet N, Didot V, Dechery T. Spontaneous coronary dissection: A rare etiology of acute coronary syndrome. Radiol Case Rep 2024; 19:1457-1462. [PMID: 38298906 PMCID: PMC10828590 DOI: 10.1016/j.radcr.2023.12.048] [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: 12/09/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024] Open
Abstract
Spontaneous coronary artery dissection is a rare etiology of acute coronary syndrome and falls into the category of myocardial infarction with no obstructive coronary arteries. It occurs mainly in young women with no cardiovascular risk factors. Diagnosis is often made by coronary angiography and sometimes by endocoronary imaging. the association of coronary dissection and ACS is rare, especially in men. The management is poorly codified and depends mainly on the habits of the practitioner, and may be medical, percutaneous or surgical. the outcome is often favorable, but sometimes there is a risk of recurrence with a guarded prognosis. In this context, we report the case of a 43-year-old patient with antecedent spontaneous coronary dissection, admitted to our unit for the management of acute coronary syndrome following recurrent coronary dissection.
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Affiliation(s)
- Zakaria el Marraki
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Tours, France
| | - Karim Mounaouir
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Casablanca, Morocco
| | - Pierre Marcolet
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Tours, France
| | - Nassim Halet
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Tours, France
| | - Valerian Didot
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Tours, France
| | - Thierry Dechery
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Tours, France
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2
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Zhang L, Wang Y, Xiao W, Shi Y, Fu W, Zhang X, Duan S. Evaluation of left ventricular function of pregnant women with autoimmune diseases using speckle tracking echocardiography. Int J Cardiovasc Imaging 2023; 39:1643-1655. [PMID: 37249654 PMCID: PMC10227406 DOI: 10.1007/s10554-023-02876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
Pregnancy can cause fluctuations in autoimmune diseases (AD) women, which may aggravate the cardiac damage. Maternal heart function is very important for maternal and fetal health. Therefore, early and accurate evaluation of the heart function of AD pregnant women is necessary. This study was aimed to evaluate the left ventricular (LV) function of AD pregnant women using two-dimensional speckle tracking echocardiography (2DSTE). A total of 96 subjects, including 26 non-pregnant AD patients (AD group), 33 AD pregnant women (AD-P group), and 37 healthy pregnant women (H-P group) were conducted. Baseline clinical and conventional echocardiography characteristics of all the subjects were collected. The 2DSTE was performed to acquire layer-specific strain parameters of LV. Compared with H-P group, AD-P group showed no significant differences in GLSmid and GLSepi. However, the GLSendo (24.10 [22.30 to 25.40] vs. 21.70 [19.05 to 25.15], P = 0.023) and ΔGLS (5.50 [4.80 to 6.00] vs. 4.90 [4.20 to 5.80], P = 0.017) were decreased, while the PSD (27 [23 to 32] vs. 32 [24 to 44], P = 0.014) was increased. At the segmental level, there was no significant difference in apex LSmid and LSepi between the two groups, while the AD-P group showed transmural dysfunction in basal and middle segments, and the LSendo in apex segments (32.84 [28.34 to 34.25] vs. 27.97 [21.87 to 33.61], P = 0.021) were significantly decreased. Compared with AD group, AD-P group showed no significant difference in ΔGLS, PSD, and GLS parameters of three layers. For the segmental level, there were no significant differences in the LSepi of the apex segment and the LS in three layers of the basal and middle segments between the two groups, while LSendo (32.69 [29.13 to 35.53] vs. 27.97 [21.87 to 33.60], P = 0.017) and LSmid (24.70 [22.24 to 27.78] vs. 21.32 [16.91 to 26.11], P = 0.023) in apex segments were significantly lower in AD-P group. The anti-SSA/Ro antibody were positive independently correlated with PSD. In conclusion, layer-specific strain parameters and PSD by 2DSTE provide an accurate and reproducible measurement of myocardial function. There are subclinical LV myocardial dysfunction in AD pregnant women. Besides, the positive of anti-SSA/Ro antibody maybe associated with LV myocardial dysfunction.
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Affiliation(s)
- Lu Zhang
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China
| | - YaXi Wang
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China
| | - WuPing Xiao
- Department of Medical Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - YiLu Shi
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China
| | - WenYan Fu
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China
| | - XiaoShan Zhang
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China.
| | - ShaSha Duan
- Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China.
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Cano-Castellote M, Afanador-Restrepo DF, González-Santamaría J, Rodríguez-López C, Castellote-Caballero Y, Hita-Contreras F, Carcelén-Fraile MDC, Aibar-Almazán A. Pathophysiology, Diagnosis and Treatment of Spontaneous Coronary Artery Dissection in Peripartum Women. J Clin Med 2022; 11:jcm11226657. [PMID: 36431134 PMCID: PMC9692787 DOI: 10.3390/jcm11226657] [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: 09/20/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an infrequent cause of nonobstructive ischemic heart disease in previously healthy young women and therefore is not usually considered in differential diagnoses. The overall incidence of SCAD in angiographic series is between 0.28 and 1.1%, with a clear predominance in young, healthy women (70%) of whom approximately 30% are in the postpartum period. In the United Kingdom, between 2008 and 2012, SCAD was the cause of 27% of acute myocardial infarctions during pregnancy, with a prevalence of 1.81 per 100,000 pregnancies. Regarding the mechanism of arterial obstruction, this may be due to the appearance of an intramural hematoma or to a tear in the intima of the arteries, both spontaneously. Although multiple diagnostic methods are available, it is suggested to include an appropriate anamnesis, an electrocardiogram in the first 10 min after admission to the service or the onset of symptoms, and subsequently, a CT angiography of the coronary arteries or urgent coronary angiography if the hemodynamic status of the patient allows it. Treatment should be individualized for each case; however, the appropriate approach is generally based on two fundamental pillars: conservative medical treatment with antiplatelet agents, beta-blockers, and nitrates, and invasive treatment with percutaneous coronary intervention for stent implantation or balloon angioplasty, if necessary.
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Affiliation(s)
- Marta Cano-Castellote
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | - Diego Fernando Afanador-Restrepo
- Faculty of Distance and Virtual Education, Antonio José Camacho University Institution, Santiago de Cali 760016, Colombia
- ZIPATEFI Research Group, Faculty of Health Sciences and Sports, University Foundation of the Área Andina, Pereira 660001, Colombia
| | - Jhonatan González-Santamaría
- ZIPATEFI Research Group, Faculty of Health Sciences and Sports, University Foundation of the Área Andina, Pereira 660001, Colombia
- Faculty of Health Sciences, Technological University of Pereira, Pereira 660001, Colombia
- Nutrition Sciences Postgraduate, Faculty of Nutrition Sciences, University of Sinaloa, Culiacan 80019, Mexico
| | | | | | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
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4
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Ahmed T, Honaker O, Misumida N, Messerli AW. Spontaneous Coronary Artery Dissection (SCAD) complicated with post-infarction ventricular septal rupture and a comparative review on mechanical complications related with SCAD. Curr Probl Cardiol 2022:101229. [DOI: 10.1016/j.cpcardiol.2022.101229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022]
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5
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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.
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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
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6
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Thube HR, Sane MR. Sudden death of a post-partum female with anomalous origin of the coronary artery with bicuspid aortic valve. Med Leg J 2022:258172211060688. [PMID: 35156433 DOI: 10.1177/00258172211060688] [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: 11/16/2022]
Abstract
Modern techniques have enabled routine diagnosis of congenital cardiac defects, notwithstanding, there will be some that remain undiagnosed and asymptomatic until adulthood. But this is rarely the case with the patent foramen ovale, with the anomalous aortic origin of the left main coronary artery and bicuspid aortic valve. This case describes the sudden death of a female in her post-partum period due to cardiac tamponade following a ruptured aneurysm of the coronary artery at its origin at the sinus of Valsalva. Autopsy shows patent foramen ovale findings and anomalous aortic origin of coronary artery (AAOCA) and bicuspid aortic valve. The association of AAOCA with bicuspid aortic valve and patent foramen ovale is rare.
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Affiliation(s)
- Harshal R Thube
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, Nagpur, India
| | - Mandar R Sane
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, Nagpur, India
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7
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Chien DV, Hai PD, Nhung LT, Son PT. Multiple spontaneous coronary artery dissections associated with intravenous daunorubicin treatment for acute myelocytic leukaemia: a case report. Eur Heart J Case Rep 2020; 5:ytaa427. [PMID: 33644638 PMCID: PMC7898587 DOI: 10.1093/ehjcr/ytaa427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/04/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Multiple spontaneous coronary artery dissection (SCAD) is a rare condition which may lead to serious consequences such as sudden cardiac death, acute myocardial infarction (AMI), and acute heart failure.
Case summary
In this paper, we report the case of a 57-year-old woman with acute myelocytic leukaemia who was undergoing her second phase of chemotherapy. After the first induction cycle of intravenous infusion of daunorubicin, the patient experienced chest pain, shortness of breath, and low blood pressure. The electrocardiograms revealed significant ST-elevation in the D1, aVL, and V2–V6 leads, which indicated AMI. Coronary catheterization showed spontaneous coronary dissection in the mid-left descending coronary artery and first obtuse marginal artery of the circumflex. The patient died immediately.
Discussion
This is the first reported case of multiple SCAD associated with intravenous (IV) daunorubicin infusion. We also reviewed the literature and proposed the mechanism of this complication.
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Affiliation(s)
- Do Van Chien
- Department of Cardiology, Military Heart Institute, 108 Central Military Hospital, No. 1 Tran Hung Dao street, Hai Ba Trung District, Hanoi 10000, Vietnam
| | - Pham Dang Hai
- Department of Intensive Care Unit, 108 Central Military Hospital, No. 1 Tran Hung Dao street, Hai Ba Trung District, Hanoi 10000, Vietnam
| | - Le Thi Nhung
- Department of Chemotherapy, 108 Central Military Hospital, No. 1 Tran Hung Dao street, Hai Ba Trung District, Hanoi 10000, Vietnam
| | - Pham Truong Son
- Department of Cardiology, Military Heart Institute, 108 Central Military Hospital, No. 1 Tran Hung Dao street, Hai Ba Trung District, Hanoi 10000, Vietnam
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8
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Affiliation(s)
- Esther S H Kim
- From the Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville
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9
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Garland J, Little D. Maternal Death and Its Investigation. Acad Forensic Pathol 2019; 8:894-911. [PMID: 31240079 DOI: 10.1177/1925362118821485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 11/16/2018] [Indexed: 12/26/2022]
Abstract
Maternal deaths are a leading cause of death in young females worldwide, particularly in developing countries. Maternal mortality ratio, the number of maternal deaths per 100 000 live births, averages 240 in developing regions, but only 16 in developed regions. Causes of maternal and pregnancy-related deaths can be subdivided into three broad categories. Direct maternal deaths result from obstetric complications of the pregnant state (i.e., pregnancy, labor, and puerperium) from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. Indirect maternal deaths result from previously existing diseases or diseases that developed during pregnancy, and which are not due to a direct obstetric cause, but are aggravated by the physiologic effects of pregnancy. Incidental maternal deaths are those from causes unrelated to pregnancy or the puerperium, including accidental deaths and homicide. Maternal deaths carry significant short- and long-term impacts for family members and the role of the pathologist is an important part of the wider knowledge-gathering process that can contribute to changes in maternal mortality rates. This paper reviews the clinical and pathological features of common pregnancy-related disorders and gives guidelines for performing an autopsy related to maternal death.
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10
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Gilhofer TS, Saw J. Spontaneous coronary artery dissection: a review of complications and management strategies. Expert Rev Cardiovasc Ther 2019; 17:275-291. [DOI: 10.1080/14779072.2019.1598261] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Thomas S. Gilhofer
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
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11
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Ahmed N, Kalininskiy A, Gandhi H, Shin JJ. Spontaneous coronary artery dissection in a postpartum e-cigarette smoker. BMJ Case Rep 2018; 2018:bcr-2018-225194. [PMID: 29866694 DOI: 10.1136/bcr-2018-225194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare but lethal cause of acute coronary syndrome that occurs in young women during the peripartum/postpartum periods. We present a case of a 41-year-old woman with no significant medical history, but was a habitual e-cigarette smoker who presented with atypical chest pain 2 weeks after an uncomplicated delivery while breast feeding. The patient was found to have elevated cardiac enzymes and ST segment elevations in the anterior leads. An urgent cardiac catheterisation was performed, which revealed dissection and occlusion of the left anterior descending artery, and a drug-eluting stent was placed that resulted in the resolution of chest pain. Physiological changes during the postpartum period may be linked to an increased risk of developing SCAD.1 In addition, e-cigarette smoking is associated with increased oxidative stress and sympathetic activity, which may predispose patients to an increased risk of acute coronary syndrome.
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Affiliation(s)
- Navid Ahmed
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Himali Gandhi
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jooyoung Julia Shin
- Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA
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12
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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: 705] [Impact Index Per Article: 117.5] [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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Alzayer H, Bossard M, Ahsan S, Tsang M, Whitlock R, Sheth T. A Case of Spontaneous Coronary Artery Dissection Complicated by Free Wall Rupture. Can J Cardiol 2017; 33:1736.e13-1736.e15. [PMID: 29173612 DOI: 10.1016/j.cjca.2017.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 11/28/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an unusual and underdiagnosed cause of nonatherosclerotic acute coronary syndrome (ACS). Patients might present in various ways including chest pain, ST-elevation ACS, ventricular arrhythmia, and sudden cardiac death. In a few reports, it manifested initially as cardiac tamponade. The association of SCAD with free wall rupture is extremely rare. We present a unique case of a 70-year-old woman who initially presented with non-ST elevation ACS and was found to have SCAD on angiography, which was subsequently complicated by cardiac tamponade with free wall rupture.
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Affiliation(s)
- Hussain Alzayer
- Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Matthias Bossard
- Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Shoeb Ahsan
- Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Tsang
- Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Richard Whitlock
- Division of Cardiac Surgery, Hamilton General Hospital, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tej Sheth
- Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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14
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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: 96] [Impact Index Per Article: 13.7] [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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15
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Byard RW, Gilbert JD, Langlois NEI. Spontaneous coronary artery dissection. Forensic Sci Med Pathol 2017; 13:248-251. [DOI: 10.1007/s12024-017-9845-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 11/29/2022]
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16
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Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography. Int J Legal Med 2015; 130:759-63. [PMID: 26126482 DOI: 10.1007/s00414-015-1215-1] [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: 01/13/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
Abstract
Coronary artery injury is a rare complication following blunt chest trauma (BCT), and can be fatal. Here we report findings on postmortem selective coronary angiography of right coronary artery rupture after an assault involving blunt trauma to the chest. A woman in her 60s died after her son stomped on her chest. There were no appreciable signs of injury on external examination, and cause of death could not be determined by postmortem computed tomography (PMCT). Internal findings indicated that an external force had been applied to the anterior chest, as evidenced by subcutaneous hemorrhage and pericardial and cardiac contusions. Postmortem coronary angiography revealed irregularity of the intima and of the fat tissue surrounding the proximal part of the right coronary artery associated with a local filling defect. Histopathological examination suggested coronary rupture with dissection of the tunica media and compression of the lumen cavity. The key points in the present case are that no fatal injuries could be determined on external examination, and the heart and coronary artery injuries were not evident on PMCT. Criminality might be overlooked in such cases, as external investigation at the crime scene would be inadequate and could result in a facile diagnosis of cause of death. This is the first report of coronary artery rupture with dissection that was detected by CT coronary angiography, and provides helpful findings for reaching an appropriate decision both forensically and clinically.
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