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Tated RCP, Maheta D, Agrawal SP, Frishman WH, Aronow WS. Ischemic Heart Disease in Pregnancy: Current Understanding and Management Strategies. Cardiol Rev 2024:00045415-990000000-00310. [PMID: 39140736 DOI: 10.1097/crd.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Ischemic heart disease (IHD) during pregnancy poses a rare but significant risk to maternal and fetal health, with global incidence rates ranging from 0.7 to 10 cases per 100,000 pregnancies. This review synthesizes current literature on the epidemiology, pathophysiology, clinical presentation, diagnosis, management, and outcomes of IHD in pregnancy. Pregnancy-related IHD encompasses various conditions, including coronary artery disease, spontaneous coronary artery dissection, myocardial infarction with nonobstructive coronary arteries, coronary embolism, and coronary vasospasm. The pathophysiology is multifactorial, involving hemodynamic changes, hormonal influences, and increased hypercoagulability. Clinical presentation may mimic typical pregnancy symptoms, necessitating a high index of suspicion for timely diagnosis. A multidisciplinary strategy is needed for management, taking into account the hazards to the mother and fetus while also taking drug safety and procedural treatments such coronary artery bypass grafting and percutaneous coronary intervention into account. Careful observation and timely management are necessary for complications such as cardiogenic shock, arrhythmias, and thromboembolic events following myocardial infarction. With advancements in treatment techniques and early discovery, the prognosis has improved, although maternal mortality is still a worry. For the purpose of improving results and directing future research endeavors, knowledge and comprehension of IHD during pregnancy are essential.
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Affiliation(s)
| | - Darshilkumar Maheta
- From the Department of Public Health, New York Medical College, Valhalla, NY
| | - Siddharth Pravin Agrawal
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI
| | | | - Wilbert S Aronow
- Department of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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2
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Borkowski P, Maliha M, Borkowski M, Borkowska N, Singh N, Chauhan A, Chowdhury I, Yakkali S, Satish V, Choi H. Myocardial Infarction With Non-obstructive Coronary Arteries (MINOCA): A Case Report and Comprehensive Discussion of Pathophysiology and Risk Factors. Cureus 2024; 16:e67144. [PMID: 39161551 PMCID: PMC11332960 DOI: 10.7759/cureus.67144] [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] [Accepted: 08/18/2024] [Indexed: 08/21/2024] Open
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) refers to the occurrence of myocardial infarction symptoms and signs despite angiographic findings showing normal or near-normal coronary arteries. Unlike the more commonly recognized myocardial infarction with coronary artery disease (MICAD), MINOCA often has a better prognosis; however, it is not without risk, as it is associated with increased mortality. We present a 72-year-old female who presented to the hospital with acute chest pain. Following a thorough diagnostic workup, including laboratory tests, left heart catheterization, and cardiac imaging, she was diagnosed with MINOCA. This case report provides a comprehensive review of the pathophysiological mechanisms underlying MINOCA, such as plaque disruption without significant stenosis, microvascular dysfunction, coronary artery spasm, coronary thrombosis or embolism, and spontaneous coronary artery dissection. Additionally, we explore the associated risk factors, highlighting the unconventional risk factors. MINOCA represents a diverse clinical condition with various causes and complex pathophysiology. The variability underscores the necessity for further research to deepen our understanding of this condition. Enhanced knowledge will lead to better diagnostic and treatment strategies, ultimately improving patient outcomes.
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Affiliation(s)
- Pawel Borkowski
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Maisha Maliha
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | | | - Natalia Borkowska
- Pediatrics, Samodzielny Publiczny Zakład Opieki Zdrowotnej (SPZOZ), Krotoszyn, POL
| | - Nikita Singh
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Abhyuday Chauhan
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Ishmum Chowdhury
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Shreyas Yakkali
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Vikyath Satish
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
| | - Hansol Choi
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
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3
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Milutinovic S, Bell A, Jancic P, Stanojevic D, Borghol AH, Mina J, Chebib FT, Khambati I, Escarcega RO, Wood MJ. Spontaneous Coronary Artery Dissection in Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review of the Literature. J Pers Med 2024; 14:702. [PMID: 39063956 PMCID: PMC11278354 DOI: 10.3390/jpm14070702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a spontaneous intimal tear of the coronary artery wall. A factor rarely associated with SCAD is autosomal dominant polycystic kidney disease (ADPKD). Using the PRISMA guidelines, we identified 10 unique cases of SCAD in ADPKD patients reported between 1998 and 2021. Ages ranged from 36 to 59 years, with an average of 44.6 years. The majority of patients were female (80%). Each case was diagnosed with a cardiovascular event: ST-elevation myocardial infarction (STEMI) in 40%, non-ST elevation myocardial infarction (NSTEMI) in 50%, and stable angina in 10%. Conservative management was used in 60% of cases. There is a significant gap in our understanding of the relationship between SCAD and ADPKD. Polycystin complex can lead to structural abnormalities in blood vessels, resulting in vascular leaks and vessel rupture. This suggests that ADPKD patients may have an elevated risk of arteriopathies, including coronary artery dissection.
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Affiliation(s)
- Stefan Milutinovic
- Internal Medicine Residency Program at Lee Health, Florida State University College of Medicine, Cape Coral, FL 33909, USA; (S.M.); (A.B.); (R.O.E.)
| | - Abraham Bell
- Internal Medicine Residency Program at Lee Health, Florida State University College of Medicine, Cape Coral, FL 33909, USA; (S.M.); (A.B.); (R.O.E.)
| | - Predrag Jancic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dragana Stanojevic
- Clinic for Cardiology, University Clinical Center Nis, 18000 Nis, Serbia;
| | - Abdul Hamid Borghol
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA; (A.H.B.); (F.T.C.)
| | - Jonathan Mina
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY 10305, USA;
| | - Fouad T. Chebib
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA; (A.H.B.); (F.T.C.)
| | | | - Ricardo O. Escarcega
- Internal Medicine Residency Program at Lee Health, Florida State University College of Medicine, Cape Coral, FL 33909, USA; (S.M.); (A.B.); (R.O.E.)
- Lee Health Heart Institute, Fort Myers, FL 33908, USA;
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4
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Jnani J, Dejanovic I, Leung C, Singh A. Current Knowledge and Challenges in the Clinical Management of Spontaneous Coronary Artery Dissection (SCAD): A Case Series. Cureus 2024; 16:e61847. [PMID: 38978916 PMCID: PMC11227981 DOI: 10.7759/cureus.61847] [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] [Accepted: 06/06/2024] [Indexed: 07/10/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare condition in which there is coronary dissection that is not due to atherosclerosis or iatrogenic causes. It is more common in young women and is associated with risk factors such as the peripartum period and connective tissue disorders. We present five unique cases of SCAD to illustrate the variety of presentations and clinical management. The youngest and oldest patients in our series were 34 and 63 years old, respectively. The majority of our patients (60%) were of African American ethnicity. Two of the patients in the case series developed a new-onset congestive heart failure, and one patient had an iatrogenic complication after intervention. The majority of the patients were treated with conservative medical management (60%), while the others were treated with primary percutaneous coronary intervention (PCI). SCAD is a rare but life-threatening disease that may have varying presentations and precipitating risk factors. As demonstrated in our case series, SCAD may present atypically, and clinicians should maintain a high degree of suspicion in a relevant presentation. Treatment of SCAD may involve conservative management, primary PCI, or coronary artery bypass grafting (CABG) depending on the case. Clinicians may also have to address complications from SCAD, such as cardiomyopathy, that may arise.
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Affiliation(s)
- Jack Jnani
- Internal Medicine, North Shore University Hospital, Manhasset, USA
| | - Ilja Dejanovic
- Cardiology, North Shore University Hospital, Manhasset, USA
| | - Christian Leung
- Internal Medicine, North Shore University Hospital, Manhasset, USA
| | - Avneet Singh
- Cardiology, North Shore University Hospital, Manhasset, USA
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5
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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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Rizi SS, Wiens E, Hunt J, Ducas R. Cardiac physiology and pathophysiology in pregnancy. Can J Physiol Pharmacol 2024. [PMID: 38815593 DOI: 10.1139/cjpp-2024-0010] [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: 06/01/2024]
Abstract
Cardiovascular disease is the leading indirect cause of maternal morbidity and mortality, accounting for nearly one third of maternal deaths during pregnancy. The burden of cardiovascular disease in pregnancy is increasing, as are the incidence of maternal morbidity and mortality. Normal physiologic adaptations to pregnancy, including increased cardiac output and plasma volume, may unmask cardiac conditions, exacerbate previously existing conditions, or create de novo complications. It is important for care providers to understand the normal physiologic changes of pregnancy and how they may impact the care of patients with cardiovascular disease. This review outlines the physiologic adaptions during pregnancy and their pathologic implications for some of the more common cardiovascular conditions in pregnancy.
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Affiliation(s)
- Shekoofeh Saboktakin Rizi
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Evan Wiens
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jennifer Hunt
- Department of Obstetrics, Gynecology & Reproductive Science, University of Manitoba, Winnipeg, MB, Canada
| | - Robin Ducas
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Obstetrics, Gynecology & Reproductive Science, University of Manitoba, Winnipeg, MB, Canada
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Krittanawong C, Patel N, Bandyopadhyay D, Maitra NS, Khawaja M, Wang Z, Alam M, Shani J, Frankel R, Sharma S, Jneid H. Spontaneous coronary artery dissection outcomes among pregnant vs. non-pregnant women. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:423-428. [PMID: 38630619 DOI: 10.1093/ehjacc/zuae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) has become increasingly recognized. It accounts for <1-4% of acute coronary syndrome presentations. Overall, however, it makes up over 40% of pregnancy-associated myocardial infarction. Furthermore, pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is described to have a greater degree of clinical manifestations, including left ventricular dysfunction, shock, and left main or multivessel involvement. The findings are disconcerting, though many studies evaluating P-SCAD are based on case series data or are single centre studies. METHODS AND RESULTS The aim of this study was to evaluate a larger national dataset to evaluate the outcomes of SCAD and specifically P-SCAD in an attempt to better characterize the severity and clinical nature of this condition. To conduct this study, we analysed the National Readmission Database from January 2016 to December 2020. Propensity matching was done using the Greedy 1:1 method. Multivariate logistics and time-to-event Cox regression analysis models were built by including all confounders significantly associated with the outcome on univariable analysis with a cut-off P-value of 0.2. In multivariate regression analysis, P-SCAD patients had a non-propensity matched odds ratio (OR) of 0.21 (0.3-1.54, P = 0.123) of dying and a propensity matched OR of 0.11 (0.02-0.61, P = 0.012) of dying. Thirty-day readmission rate for P-SCAD was 15.8% (n = 93) and for non-pregnant spontaneous coronary artery dissection (NP-SCAD) was 11.2% (n = 2286); non-propensity matched OR for readmission for PSCAD patients was 1.68 (1.24-2.29, P = 0.001) and propensity matched OR was 3.39 (1.93-5.97, P < 0.001). CONCLUSION Among hospitalized patient, P-SCAD was associated with similar clinical outcomes and reduced incidence of death when compared with NP-SCAD, though had higher rates of 30-day readmission. Larger-scale observational data will be needed to ascertain the true incidence of cardiovascular complications as it relates to P-SCAD.
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Affiliation(s)
- Chayakrit Krittanawong
- Cardiology Division, New York University Langone Health and New York University School of Medicine, New York, NY 10016, USA
| | - Neelkumar Patel
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiovacular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | | | - Muzamil Khawaja
- Department of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Mahboob Alam
- The Texas Heart Institute, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jacob Shani
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Robert Frankel
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Samin Sharma
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, NY 10029, USA
| | - Hani Jneid
- John Sealy Distinguished Centennial Chair in Cardiology, Chief, Division of Cardiology, University of Texas Medical Branch, Houston, TX 77030, USA
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8
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Schneider A, Gharacholou SM. Spontaneous Coronary Artery Dissection in a Male Patient With Fibromuscular Dysplasia. Tex Heart Inst J 2024; 51:e238358. [PMID: 38722191 PMCID: PMC11080985 DOI: 10.14503/thij-23-8358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
A male patient presented with cardiac arrest attributed to anterior ST-segment elevation myocardial infarction from type 1 spontaneous coronary artery dissection. Subsequent imaging confirmed fibromuscular dysplasia in noncoronary arterial segments. The patient was started on guideline-directed medical therapy and referred to cardiac rehabilitation, showing substantial improvements in clinical status. With greater awareness and advancements in imaging, spontaneous coronary artery dissection has been more frequently recognized, and although as many as 81% to 92% of all cases occur in female patients, it can be seen among men, as well. Adjunctive imaging for arteriopathies may help establish the diagnosis for equivocal causes of acute coronary syndrome in women and men.
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Affiliation(s)
- Artur Schneider
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
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Hosseini K, Fallahtafti P, Roudbari P, Soleimani H, Jahromi NA, Jameie M, Jenab Y, Moradi A, Ajam A, Heydari N, Kuno T, Narula N, Kampaktsis PN. Spontaneous coronary artery dissection in patients with prior psychophysical stress: a systematic review of case reports and case series. BMC Cardiovasc Disord 2024; 24:235. [PMID: 38702627 PMCID: PMC11067298 DOI: 10.1186/s12872-024-03902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome, particularly in younger women. Due to limited information about SCAD, case reports and case series can provide valuable insights into its features and management. This study aimed to comprehensively evaluate the features of SCAD patients who experienced psychophysical stress before the SCAD event. METHODS We conducted an electronic search of PubMed, Scopus, and Web of Science from inception until January 7, 2023. We included case reports or series that described patients with SCAD who had experienced psychophysical stress before SCAD. Patients with pregnancy-associated SCAD were excluded from our analysis. RESULTS In total, we included 93 case reports or series describing 105 patients with SCAD. The average patient age was 44.29 ± 13.05 years and a total of 44 (41.9%) of patients were male. Among the included SCAD patients the most prevalent comorbidities were fibromuscular dysplasia (FMD) and hypertension with the prevalence of 36.4 and 21.9%, respectively. Preceding physical stress was more frequently reported in men than in women; 38 out of 44 (86.4%) men reported physical stress, while 36 out of 61 (59.1%) females reported physical stress (p value = 0.009). On the other hand, the opposite was true for emotional stress (men: 6 (13.6%)), women: 29 (47.6%), p value < 0.001). Coronary angiography was the main diagnostic tool. The most frequently involved artery was the left anterior descending (LAD) (62.9%). In our study, recurrence of SCAD due to either the progression of a previous lesion or new SCAD in another coronary location occurred more frequently in those treated conservatively, however the observed difference was not statistically significant (p value = 0.138). CONCLUSION While physical stress seems to precede SCAD in most cases, emotional stress is implicated in females more than males.
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Affiliation(s)
- Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Parisa Fallahtafti
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Roudbari
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Soleimani
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran.
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran.
- Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, 1411713139, Iran.
| | - Negin Abiri Jahromi
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Mana Jameie
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Yaser Jenab
- Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
- Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Ali Moradi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ajam
- Department of Medicine and Vascular Medicine Institute, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, USA
| | - Narges Heydari
- Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Toshiki Kuno
- Department of Medicine, Montefiore Medical Center, New York, NY, 10461, USA
| | - Nupoor Narula
- Weill Cornell Medicine, New York Presbyterian, New York City, USA
| | - Polydoros N Kampaktsis
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, 10032, USA
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10
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Grant E, Sanghavi M. Ischemic Heart Disease in Women. Med Clin North Am 2024; 108:567-579. [PMID: 38548464 DOI: 10.1016/j.mcna.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
This review synthesizes the current understanding of ischemic heart disease in women, briefly discussing differences in risk factors, presentation, and treatment. We have underscored the unique clinical phenotype of IHD in women with a higher prevalence of ischemia with non-obstructive coronary arteries. Further research is needed to elucidate the complexities of ischemic heart disease in women, understand the discordance between ischemic burden and clinical symptoms, and optimize treatment strategies.
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Affiliation(s)
- Eleonore Grant
- Department of Internal Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Monika Sanghavi
- Division of Cardiology, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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11
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Dimagli A, Malas J, Chen S, Sandner S, Schwann T, Tatoulis J, Puskas J, Bowdish ME, Gaudino M. Coronary Artery Aneurysms, Arteriovenous Malformations, and Spontaneous Dissections-A Review of the Evidence. Ann Thorac Surg 2024; 117:887-896. [PMID: 38081498 DOI: 10.1016/j.athoracsur.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Coronary artery aneurysms (CAAs), coronary arteriovenous malformations (CAVMs), and spontaneous coronary artery dissections (SCADs) are rare clinical entities, and much is unknown about their natural history, prognosis, and management. METHODS A systematic search of MEDLINE, Embase, and Cochrane Library databases was performed in March 2023 to identify published papers related to CAAs, CAVMs, and SCADs. RESULTS CAAs are found in 0.3% to 12% of patients undergoing angiography and are often associated with coronary atherosclerosis. They are usually asymptomatic but can be complicated by thrombosis in up to 4.8% of patients and rarely by rupture (0.2%). CAAs can be managed medically, percutaneously with stents or coil embolization, and surgically. The most common surgical procedure is ligation of the aneurysm, followed by coronary artery bypass grafting. The incidence of CAVMs is 0.1% to 0.2% in patients undergoing angiography, and they are most likely associated with congenital abnormal development of the coronary vessels. The diagnosis of CAVMs is usually incidental. Surgical or percutaneous intervention is indicated for patients with large CAVMs, which carry a potential risk of myocardial infarction. SCADs represent 1% to 4% of all acute coronary syndromes and typically affect young women. SCADs are strongly correlated with pregnancy, suggesting the role of sex hormones in their pathogenesis. Conservative management of SCAD is preferred for stable patients without signs of ischemia as spontaneous resolution is frequently reported. Unstable patients should undergo revascularization either percutaneously or with coronary artery bypass grafting. CONCLUSIONS Further evidence regarding the management of these rare diseases is needed and can ideally be derived from multicenter collaborations.
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Affiliation(s)
- Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Jad Malas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sarah Chen
- Division of Cardiac Surgery, University of California Davis Health, Sacramento, California
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schwann
- Department of Surgery, University of Massachusetts-Baystate, Springfield, Massachusetts
| | - James Tatoulis
- The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, New York
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
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12
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Haney AC, Siry D, Hoerbrand IAR, Ehlermann P, Beckendorf J. Spontaneous pregnancy-associated coronary artery dissection: a case report on diagnostic and therapeutic challenges. Eur Heart J Case Rep 2024; 8:ytae204. [PMID: 38707531 PMCID: PMC11065351 DOI: 10.1093/ehjcr/ytae204] [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: 11/07/2023] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
Abstract
Background One of the main causes of myocardial infarction during pregnancy is spontaneous coronary artery dissection. This is ascribed to hormonal changes during pregnancy leading to a weakening of the vessel wall and haemodynamic changes especially during childbirth. Management options include conservative medical treatment and percutaneous coronary intervention, depending on clinical presentation. Case summary A 37-year-old woman presented with typical chest pain six weeks after giving birth to her third child. Echocardiography revealed a moderate reduction in systolic function. Initial invasive coronary angiography showed no abnormalities. After cardiac magnetic resonance demonstrated extensive scar, invasive coronary angiography was repeated including intravascular imaging. A dissection of the left anterior descending artery was visualized and treated by percutaneous coronary intervention and stenting. Left ventricular function was normalized at three-month follow-up. In this educational case report, we highlight the diagnostic and therapeutic challenges when treating this special patient cohort and the importance of cardiovascular imaging. Discussion Pregnancy-associated spontaneous coronary dissection is a potential differential diagnosis when treating post-partum women with recent onset chest pain. Management is challenging and intravascular imaging to visualize dissection should be performed during invasive coronary angiography. Patients require interdisciplinary care within a pregnancy heart team.
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Affiliation(s)
- Ailís Ceara Haney
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Deborah Siry
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Isabel Amber-Rose Hoerbrand
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Jan Beckendorf
- Department of Internal Medicine III, Division of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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13
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Zilio F, Musella F, Ceriello L, Ciliberti G, Pavan D, Manes MT, Selimi A, Scicchitano P, Iannopollo G, Albani S, Fortuni F, Grimaldi M, Colivicchi F, Oliva F. Sex differences in patients presenting with acute coronary syndrome: a state-of-the-art review. Curr Probl Cardiol 2024; 49:102486. [PMID: 38428554 DOI: 10.1016/j.cpcardiol.2024.102486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
Cardiovascular conditions in the spectrum of acute coronary syndromes are characterized by sex differences with regard to pathophysiology, risk factors, clinical presentation, invasive and pharmacologic treatment, and outcomes. This review delves into these differences, including specific subsets like myocardial infarction with non-obstructed coronary arteries or Spontaneous Coronary Artery Dissection, and alternative diagnoses like Takotsubo cardiomyopathy or myocarditis. Moreover, practical considerations are enclosed, on how a sex-specific approach should be integrated in clinical practice: in fact, personal history should focus on female-specific risk factors, and hormonal status and hormonal therapy should be assessed. Moreover, physical and psychological stressors should be investigated, particularly in the event of Spontaneous Coronary Artery Dissection or Takotsubo cardiomyopathy.
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Affiliation(s)
- Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, APSS, 2, Largo Medaglie d'Oro, Trento 38123, Italy.
| | - Francesca Musella
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Cardiology Department, Santa Maria delle Grazie Hospital, Naples, Italy
| | - Laura Ceriello
- Cardiology Department, Ospedale Civile G. Mazzini, Teramo, Italy
| | - Giuseppe Ciliberti
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Daniela Pavan
- Cardiology Unit, Azienda Sanitaria "Friuli Occidentale", Pordenone, Italy
| | | | - Adelina Selimi
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | | | - Gianmarco Iannopollo
- Department of Cardiology, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Stefano Albani
- Division of Cardiology, U. Parini Hospital, Aosta, Italy; Cardiovascular Institute Paris Sud, Massy, France
| | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital "F. Miulli", Bari, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Fabrizio Oliva
- Cardiologia 1, A. De Gasperis Cardicocenter, ASST Niguarda, Milan, Italy
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14
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Petre I, Iurciuc S, Buleu F, Petre I, Moleriu RD, Popa D, Turi V, Bordianu A, Tasdemir R, Craciun LM, Marc L, Barna FM, Iurciuc M. The Impact of Medical Physical Training and a Structured Personalized Exercise Training Program on Hemodynamic Parameters and Arterial Stiffness in Pregnant Women. Biomedicines 2024; 12:986. [PMID: 38790947 PMCID: PMC11118944 DOI: 10.3390/biomedicines12050986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION In developed countries, heart disease is the primary cause of maternal mortality during pregnancy. Arterial stiffness, an independent risk factor for atherosclerosis and a predictor of cardiovascular complications, can be assessed using the augmentation index (AIx) and pulse wave velocity (PWV). In this prospective study, we aimed to evaluate diverse hemodynamic parameters and arterial stiffness in pregnant women before and after participating in a structured, personalized exercise training program. MATERIALS AND METHODS Forty healthy pregnant women, non-smokers, who agreed to participate daily for 12 weeks in a physical exercise training program under the supervision of a team made up of an obstetrician, a cardiologist, and a physiotherapist were included. Anthropometric characteristics, arterial function, and physical activity data were collected from the participants at two different time points: at the beginning of the exercise training program (T0) and at the end, after 12 weeks (T1). RESULTS Upon conducting a statistical analysis, it was discovered that there were noteworthy disparities (p = 0.05) in body mass index, brachial AIx, systolic blood pressure, and pulse pressure values between the two time points. The regression analysis for the AIx brachial values and the PWVao values from Trim II (T0) and Trim III (T1) showed major differences between these two time points; the association between the AIx brachial values in the second and third trimesters of pregnancy revealed a strong direct significant correlation (p < 0.001), and the correlation between the PWVao values in the second (T0) and third trimester (T1) of pregnancy was weak and insignificant (p = 0.12). CONCLUSIONS The findings of our study indicate that a personalized exercise training program positively impacts the physical and psychological well-being of pregnant women, leading to a reduction in PWV.
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Affiliation(s)
- Izabella Petre
- Department XII of Obstetrics and Gynaecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- County Emergency Clinical Hospital “Pius Brinzeu”, 300732 Timisoara, Romania; (F.B.); (R.T.)
| | - Stela Iurciuc
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.M.C.); (M.I.)
| | - Florina Buleu
- County Emergency Clinical Hospital “Pius Brinzeu”, 300732 Timisoara, Romania; (F.B.); (R.T.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.M.C.); (M.I.)
| | - Ion Petre
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.P.); (D.P.)
- Department of Functional Sciences, Medical Informatics and Biostatistics Discipline, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Radu Dumitru Moleriu
- Department of Functional Sciences, Medical Informatics and Biostatistics Discipline, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Daian Popa
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.P.); (D.P.)
- Department of Surgery, Emergency Discipline, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Vladiana Turi
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Anca Bordianu
- Department of Plastic Surgery and Reconstructive Microsurgery Bagdasar-Arseni, Emergency Hospital Bucharest, University of Medicine and Pharmacy “Carol Davila”, 010825 Bucharest, Romania;
| | - Rabia Tasdemir
- County Emergency Clinical Hospital “Pius Brinzeu”, 300732 Timisoara, Romania; (F.B.); (R.T.)
| | - Laura Maria Craciun
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.M.C.); (M.I.)
| | - Luciana Marc
- Centre for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Flavia Mirela Barna
- Department of Finance, Faculty of Economics and Business Administration, West University of Timisoara, 300115 Timisoara, Romania;
| | - Mircea Iurciuc
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (L.M.C.); (M.I.)
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15
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Korkontzelos I, Kotsia A, Mpourazanis G, Natsios A, Korkontzelou PD, Karanikis P, Pappa E, Papalexis P. Marfan Syndrome Associated With Acute Myocardial Infarction in the First Trimester of Pregnancy. Cureus 2024; 16:e59182. [PMID: 38807841 PMCID: PMC11130601 DOI: 10.7759/cureus.59182] [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] [Accepted: 04/28/2024] [Indexed: 05/30/2024] Open
Abstract
Marfan syndrome (MFS) is a rare hereditary connective tissue disorder with autosomal dominant inheritance associated with an increased risk of cardiovascular complications due to connective tissue fragility. Acute myocardial infarction during pregnancy is also a rare event associated with poor maternal and fetal outcomes. Herein, we report a case of a 30-year-old pregnant woman with a known history of MFS. The patient had been treated surgically for an ascending aorta aneurysm and mechanical prosthetic aortic valve repair. She presented at 12 weeks of gestation with severe chest pain, which proved to be acute myocardial infarction. This is believed to be the first case of this complex medical condition presented in the first trimester of pregnancy.
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Affiliation(s)
- Ioannis Korkontzelos
- Department of Obstetrics and Gynecology, Ioannina State General Hospital "G. Chatzikosta", Ioannina, GRC
| | - Anna Kotsia
- Department of Cardiology, Ioannina State General Hospital "G. Chatzikosta", Ioannina, GRC
| | - George Mpourazanis
- Department of Obstetrics and Gynecology, Ioannina State General Hospital "G. Chatzikosta", Ioannina, GRC
| | - Angelos Natsios
- Department of Obstetrics and Gynecology, Ioannina State General Hospital "G. Chatzikosta", Ioannina, GRC
| | | | - Pavlos Karanikis
- Department of Cardiology, Ioannina State General Hospital "G. Chatzikosta", Ioannina, GRC
| | - Evgenia Pappa
- Department of Cardiology, Ioannina State General Hospital "G. Chatzikosta", Ioannina, GRC
| | - Petros Papalexis
- Department of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, GRC
- Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
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16
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Luciano A, Cerimele C, Mecchia D, Mozzani M, Steffani S, D’Errico F, Di Donna C, De Stasio V, Garaci F, Chiocchi M. The role of cardiac computed tomography in diagnostic and prognostic assessment of pregnancy related spontaneous coronary artery dissection: a case report. Oxf Med Case Reports 2024; 2024:omae030. [PMID: 38680778 PMCID: PMC11049560 DOI: 10.1093/omcr/omae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/16/2024] [Accepted: 03/08/2024] [Indexed: 05/01/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is the most common cause of myocardial infarction during pregnancy or the postpartum period and has a major impact on cardiovascular morbidity and death in pregnant women. A 38-year-old woman with sudden cardiac arrest ten days postpartum urgently underwent coronarography, which showed an intraparietal hematoma of the left anterior descending (LAD) artery. Two days later, coronary computed tomography angiography (CCTA) was performed, which showed the evidence of SCAD in the mid-distal tract of LAD and the presence of transmural ischemic infarction in the apex and mid antero-septal wall in delayed acquisition. The patient was treated with a beta-blocker. Four months later CCTA showed complete resolution of SCAD and evolution of the infarcted areas. Given the high accuracy and noninvasiveness of CCTA, our case highlights the potential role of this imaging modality in the diagnosis and follow-up of pregnancy associated SCAD.
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Affiliation(s)
- Alessandra Luciano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Cecilia Cerimele
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Mecchia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marcello Mozzani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Simone Steffani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca D’Errico
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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17
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Martinez KA, Gudenkauf B, Ratchford EV, Kim ESH, Sharma G. Spontaneous coronary artery dissection: a focus on post-dissection care for the vascular medicine clinician. Front Cardiovasc Med 2024; 11:1352700. [PMID: 38572306 PMCID: PMC10989683 DOI: 10.3389/fcvm.2024.1352700] [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: 12/08/2023] [Accepted: 02/19/2024] [Indexed: 04/05/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an uncommon condition which is increasingly recognized as a cause of significant morbidity. SCAD can cause acute coronary syndrome and myocardial infarction (MI), as well as sudden cardiac death. It presents similarly to atherosclerotic MI although typically in patients with few or no atherosclerotic risk factors, and particularly in women. As more patients are recognized to have this condition, there is a great need for clinician familiarity with diagnostic criteria, as well as with contemporary treatment approaches, and with appropriate patient-centered counseling, including genetic testing, exercise recommendations, and psychological care. The standard of care for patients with SCAD is rapidly evolving. This review therefore summarizes the diagnosis of SCAD, epidemiology, modern treatment, cardiac rehabilitation and preconception counseling, and the current approach to genetic testing, exercise recommendations, and psychological care, all of which are crucial to the vascular medicine specialist.
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Affiliation(s)
- Katherine A. Martinez
- Biochemistry Undergraduate Program, Loyola University Maryland, Baltimore, MD, United States
| | - Brent Gudenkauf
- The Texas Heart Institute Fellowship Program, Houston, TX, United States
| | - Elizabeth V. Ratchford
- Johns Hopkins Center for Vascular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Esther S. H. Kim
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte NC, United States
| | - Garima Sharma
- Johns Hopkins Center for Vascular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
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18
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Gowda SN, Garapati SS, Kurrelmeyer K. Spectrum of Ischemic Heart Disease Throughout a Woman's Life Cycle. Methodist Debakey Cardiovasc J 2024; 20:81-93. [PMID: 38495657 PMCID: PMC10941714 DOI: 10.14797/mdcvj.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/10/2024] [Indexed: 03/19/2024] Open
Abstract
Ischemic heart disease (IHD) is the leading cause of morbidity and mortality in both genders; however, young women fare the worst, likely reflecting the more complex spectrum of IHD in women when compared to men. Substantial sex-based differences exist in the underlying risk factors, risk enhancers, presentation, diagnosis, and pathophysiology of IHD that are mainly attributed to the influence of female sex hormones. This article reviews the spectrum of IHD including obstructive epicardial coronary artery disease (CAD), myocardial infarction with no obstructive coronary artery disease, ischemia with no obstructive coronary artery disease, spontaneous coronary artery dissection, coronary microvascular dysfunction, vasospastic angina, and coronary thrombosis/embolism that occur in women throughout various stages of their life cycle. We aim to update clinicians on the diagnosis and management of these various types of IHD and highlight where further randomized controlled studies are needed to determine optimal treatment and inform guideline-directed medical therapy.
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Affiliation(s)
- Smitha Narayana Gowda
- Methodist DeBakey Cardiology Associates
- Houston Methodist Hospital, Houston, Texas, US
| | - Sai sita Garapati
- Methodist DeBakey Cardiology Associates
- Houston Methodist Hospital, Houston, Texas, US
| | - Karla Kurrelmeyer
- Methodist DeBakey Cardiology Associates
- Houston Methodist Hospital, Houston, Texas, US
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19
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Nguyen AH, Murrin E, Moyo A, Sharma G, Sullivan SA, Maxwell GL, Kennedy JLW, Saad AF. Ischemic heart disease in pregnancy: a practical approach to management. Am J Obstet Gynecol MFM 2024; 6:101295. [PMID: 38278176 DOI: 10.1016/j.ajogmf.2024.101295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024]
Abstract
Ischemic heart disease is a crucial issue during pregnancy. The term is composed of both preexisting conditions and acute coronary syndrome in pregnancy, including pregnancy-associated myocardial infarction, which can have a significant effect on maternal and fetal outcomes. This review provides a complete guide to managing ischemic heart disease in pregnant women, emphasizing the importance of multidisciplinary care and individualized treatment strategies. Cardiovascular disease, particularly ischemic heart disease, is now the leading cause of maternal mortality worldwide. Pregnancy introduces unique physiological changes that increase the risk of acute myocardial infarction, with pregnancy-associated myocardial infarction cases often associated with factors, such as advanced maternal age, chronic hypertension, and preexisting cardiovascular conditions. This review distinguishes between preexisting ischemic heart disease and pregnancy-associated myocardial infarction. It will emphasize the various etiologies of pregnancy-associated myocardial infarction, including coronary atherosclerosis and plaque rupture presenting as ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and other nonatherosclerotic causes, including spontaneous coronary artery dissection, vasospasm, and embolism. Our study discusses the practical management of ischemic heart disease in pregnancy, with a focus on preconception counseling, risk assessment, and tailored antenatal planning for women with preexisting ischemic heart disease. Moreover, this document focuses on the challenges of diagnosing cardiovascular disease, especially when presented with nonclassical risk factors and presentation. It provides insight into the appropriate diagnostic testing methods, such as electrocardiogram, cardiac biomarkers, and echocardiography. In addition, the review covers various treatment strategies, from medical management to more invasive procedures, including coronary angiography, percutaneous coronary intervention, and coronary artery bypass graft. Special attention is given to medication safety during pregnancy, including anticoagulation, beta-blockers, and antiplatelet agents. The complexities of delivery planning in women with ischemic heart disease are discussed, advocating for a multidisciplinary team-based approach and careful consideration of the timing and mode of delivery. Furthermore, the roles of breastfeeding and postpartum care are explored, emphasizing the long-term benefits and the suitability of various medications during lactation. Lastly, this review provides crucial insights into the management of ischemic heart disease in pregnancy, stressing the need for heightened awareness, prompt diagnosis, and tailored management to optimize maternal and fetal health outcomes.
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Affiliation(s)
- Andrew H Nguyen
- Department of Internal Medicine, Inova Fairfax Hospital, Falls Church, Virginia (Drs Nguyen and Moyo)
| | - Ellen Murrin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia (Drs Murrin, Sullivan, and Saad)
| | - Axucillia Moyo
- Department of Internal Medicine, Inova Fairfax Hospital, Falls Church, Virginia (Drs Nguyen and Moyo)
| | - Garima Sharma
- Department of Cardiology, Inova Schar Heart and Vascular Institute, Falls Church, Virginia (Drs Sharma and Kennedy)
| | - Scott A Sullivan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia (Drs Murrin, Sullivan, and Saad)
| | - George L Maxwell
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia (Dr Maxwell)
| | - Jamie L W Kennedy
- Department of Cardiology, Inova Schar Heart and Vascular Institute, Falls Church, Virginia (Drs Sharma and Kennedy)
| | - Antonio F Saad
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia (Drs Murrin, Sullivan, and Saad).
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20
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Lee O, Sun K, Goldstein E, Jang J, Berenberg J. An Unusual Presentation of SCAD in a Young Male Soldier. Mil Med 2024; 189:e888-e893. [PMID: 37651581 DOI: 10.1093/milmed/usad347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/10/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic cause of myocardial infarction and sudden cardiac death in young individuals without significant cardiovascular risk factors. The etiology of SCAD appears to be multifactorial and is often precipitated by physical and emotional stress superimposed on underlying arteriopathy, connective tissue disorders, systemic inflammatory disorders, genetic factors, and hormonal influences. There are no current societal guidelines to stratify young soldiers' risk of developing SCAD. Diagnosis typically requires invasive coronary artery angiography which is largely unavailable in stations with limited medical resources. Furthermore, young patients with SCAD often present with atypical cardiac symptoms, such as heartburn leading to the misdiagnosis of gastroesophageal reflux disease and a delay in diagnosis and management. We present a 21-year-old active duty male who was transferred from Okinawa, Japan to a tertiary military medical center for evaluation of hypercoagulable conditions after CT revealed non-obstructing portal venous thrombosis extending to right hepatic vein, splenic vein thrombosis with splenic infarct, and bilateral wedge-shaped renal infarct. Extensive work-up ultimately revealed mid-left anterior descending spiral dissection with transmural infarct of inferior, anteroseptal, and inferoseptal wall resulting in the formation of left ventricular thrombus, subsequently causing thromboembolism to multiple organs. This case demonstrates the ramifications of SCAD when diagnosis and management are delayed and serve as a poignant reminder for all providers to include SCAD in the differential diagnosis for young soldiers with atypical chest pain.
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Affiliation(s)
- Oliver Lee
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Kelly Sun
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Elianna Goldstein
- Department of Radiology, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - James Jang
- 607th Combat Weather Squadron Unit 15173, APO, AP 96271, USA
| | - Jeffrey Berenberg
- Department of Hematology/Oncology, Tripler Army Medical Center, Honolulu, HI 96859, USA
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21
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Kim JA, Kim SY, Virk HUH, Alam M, Sharma S, Johnson MR, Krittanawong C. Acute Myocardial Infarction in Pregnancy. Cardiol Rev 2024:00045415-990000000-00222. [PMID: 38411170 DOI: 10.1097/crd.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Pregnancy-associated myocardial infarction is an overall uncommon event, but can be associated with significant maternal and fetal morbidity and mortality. In contrast to myocardial infarction in the general nonpregnant population, the mechanism of pregnancy-associated myocardial infarction is most commonly due to nonatherosclerotic mechanisms such as coronary dissection, vasospasm, or thromboembolism. The diagnosis of pregnancy-associated myocardial infarction can be challenging, requiring a high index of suspicion for prompt recognition and management. Furthermore, the management of pregnancy-associated myocardial infarction can be complex due to maternal and fetal considerations and may vary based on the specific underlying mechanism of the myocardial infarction. This review aims to review the recent literature on pregnancy-associated myocardial infarction and summarize the epidemiology, mechanisms, diagnosis, and treatment strategies for this uncommon entity.
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Affiliation(s)
- Jitae A Kim
- From the Department of Cardiology, University of Buffalo, New York, NY
| | - Sophie Y Kim
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, El Paso, TX
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Mahboob Alam
- Division of Cardiology, The Texas Heart Institute, Baylor College of Medicine, Houston, TX
| | - Samin Sharma
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, NY
| | - Mark R Johnson
- Academic Department of Obstetrics and Gynaecology, Institute of Reproductive and Developmental Biology, Chelsea and Westminster Hospital, Imperial College London, London, UK; and
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22
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:55-161. [PMID: 37740496 DOI: 10.1093/ehjacc/zuad107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
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23
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Nguyen AH, Hurwitz M, Sullivan SA, Saad A, Kennedy JLW, Sharma G. Update on sex specific risk factors in cardiovascular disease. Front Cardiovasc Med 2024; 11:1352675. [PMID: 38380176 PMCID: PMC10876862 DOI: 10.3389/fcvm.2024.1352675] [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: 12/08/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide and accounts for roughly 1 in 5 deaths in the United States. Women in particular face significant disparities in their cardiovascular care when compared to men, both in the diagnosis and treatment of CVD. Sex differences exist in the prevalence and effect of cardiovascular risk factors. For example, women with history of traditional cardiovascular risk factors including hypertension, tobacco use, and diabetes carry a higher risk of major cardiovascular events and mortality when compared to men. These discrepancies in terms of the relative risk of CVD when traditional risk factors are present appear to explain some, but not all, of the observed differences among men and women. Sex-specific cardiovascular disease research-from identification, risk stratification, and treatment-has received increasing recognition in recent years, highlighting the current underestimated association between CVD and a woman's obstetric and reproductive history. In this comprehensive review, sex-specific risk factors unique to women including adverse pregnancy outcomes (APO), such as hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus, preterm delivery, and newborn size for gestational age, as well as premature menarche, menopause and vasomotor symptoms, polycystic ovarian syndrome (PCOS), and infertility will be discussed in full detail and their association with CVD risk. Additional entities including spontaneous coronary artery dissection (SCAD), coronary microvascular disease (CMD), systemic autoimmune disorders, and mental and behavioral health will also be discussed in terms of their prevalence among women and their association with CVD. In this comprehensive review, we will also provide clinicians with a guide to address current knowledge gaps including implementation of a sex-specific patient questionnaire to allow for appropriate risk assessment, stratification, and prevention of CVD in women.
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Affiliation(s)
- Andrew H. Nguyen
- Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, United States
| | - Madelyn Hurwitz
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Scott A. Sullivan
- Department of Maternal Fetal Medicine, Inova Fairfax Hospital, Falls Church, VA, United States
| | - Antonio Saad
- Department of Maternal Fetal Medicine, Inova Fairfax Hospital, Falls Church, VA, United States
| | - Jamie L. W. Kennedy
- Department of Cardiology, Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
| | - Garima Sharma
- Department of Cardiology, Inova Schar Heart and Vascular Institute, Falls Church, VA, United States
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Agwuegbo CC, Ahmed EN, Olumuyide E, Moideen Sheriff S, Waduge SA. Spontaneous Coronary Artery Dissection: An Updated Comprehensive Review. Cureus 2024; 16:e55106. [PMID: 38558647 PMCID: PMC10979520 DOI: 10.7759/cureus.55106] [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] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is defined as a non-iatrogenic, non-traumatic separation of the coronary artery wall, which has gained considerable recognition as an important cause of acute coronary syndrome. Despite the emerging evidence, it is still frequently missed and requires a high index of suspicion, as failure to accurately identify SCAD promptly could prove fatal. SCAD is most prevalent among middle-aged women, although it can also be found in men and postmenopausal women. Risk factors of SCAD include exogenous hormone use, physical and emotional stressors, pregnancy, and several inflammatory and connective tissue disorders. COVID-19 also contributes to the prevalence of SCAD. SCAD is classified into four main types based on the angiographic findings - type 1, type 2, type 3, and type 4. The gold standard for diagnosis is coronary angiography; however, intracardiac imaging is useful if diagnostic doubts persist. Despite the increasing recognition of this disease, there is a paucity in the guidelines on the management of SCAD. Management may be conservative, medical, or interventional. Cardiac rehabilitation is also necessary in the management of patients with SCAD. In light of the gaps in evidence, the authors aim to provide a comprehensive review of the existing literature, outlining the pathophysiology, classification, and, most importantly, the evidence and pitfalls circulating diagnosis, acute, and long-term management of SCAD.
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Affiliation(s)
| | - Eman N Ahmed
- Internal Medicine, Alfaisal University College of Medicine, Riyadh, SAU
| | | | | | - Sahani A Waduge
- Internal Medicine, University of Science and Technology, Chittagong, BGD
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Civieri G, Vadori M, Masiero G, Iop L, Tansella D, Pergola V, Cozzi E, Iliceto S, Tona F. Spontaneous coronary artery dissection in women with acute myocardial infarction: is there a new role for autoimmunity? EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:856-861. [PMID: 37389577 DOI: 10.1093/ehjacc/zuad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction in women and has an unclear pathophysiology. Autoantibodies (AAs) targeting angiotensin-II receptor type 1 (AT1R) and endothelin-1 receptor type A (ETAR) have known detrimental effects on endothelial function. We investigated the prevalence of these AAs in SCAD-affected female patients. METHODS AND RESULTS Female patients diagnosed at coronary angiography with myocardial infarction and SCAD were consecutively enrolled. Autoantibodies targeting angiotensin-II receptor type 1 and ETAR-AA titres and seropositivity prevalence were compared between SCAD patients, ST-elevation myocardial infarction (STEMI) patients, and healthy women. Ten women with SCAD and 20 age-matched controls (10 women with STEMI and 10 healthy women) were included. Six out of 10 (60%) women with myocardial infarction and SCAD were seropositive for AT1R-AAs and ETAR-AAs. In contrast, only one (10%) healthy woman and one (10%) STEMI patient were seropositive for AT1R-AAs (P = 0.03 and P = 0.03, respectively). One STEMI patient was seropositive for ETAR-AAs, while none of the healthy women was found to be seropositive (P = 0.03 and P = 0.01, respectively). The median AA titre was significantly higher in SCAD patients than in healthy women (P = 0.01 for AT1R-AAs; P = 0.02 for ETAR-AAs) and STEMI patients (P < 0.001 for AT1R-AAs; P = 0.002 for ETAR-AAs). CONCLUSION Autoantibodies targeting angiotensin-II receptor type 1 and ETAR-AA seropositivity is significantly higher in SCAD women with myocardial infarction than in healthy women or female patients with STEMI. Our findings, corroborated by previous data in the literature and biological plausibility, suggest a possible role for AT1R-AAs and ETAR-AAs in the pathophysiology of SCAD in women with acute myocardial infarction and should warrant further studies with larger sample sizes.
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Affiliation(s)
- Giovanni Civieri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Marta Vadori
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Laura Iop
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Donatella Tansella
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Emanuele Cozzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Francesco Tona
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
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Akita K, Malik A, Briasoulis A, Kuno T. The relationship between spontaneous coronary artery dissection and COVID-19. J Cardiovasc Med (Hagerstown) 2023; 24:933-935. [PMID: 37642654 DOI: 10.2459/jcm.0000000000001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Keitaro Akita
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center, New York, New York
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center
- Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
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Matsushita T, Arakaki T, Sekizawa A, Hasegawa J, Tanaka H, Katsuragi S, Nakata M, Murakoshi T, Ikeda T, Ishiwata I. Pregnancy-related maternal deaths due to cardiovascular diseases in Japan from 2010 to 2019: an analysis of maternal death exploratory committee data. J Matern Fetal Neonatal Med 2023; 36:2175207. [PMID: 36750232 DOI: 10.1080/14767058.2023.2175207] [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: 02/09/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is the leading cause of maternal deaths in high-income countries. This study aimed to assess the characteristics of maternal deaths due to CVDs and the quality of care provided to patients, and to identify elements to improve maternal care in Japan. METHODS This descriptive study used the maternal death registration data of the Maternal Deaths Exploratory Committee of Japan between 2010 and 2019. RESULTS Of 445 eligible pregnancy-related maternal deaths, 44 (9.9%) were attributed to CVD. The most frequent cause was aortic dissection (18 patients, 40.9%), followed by peripartum cardiomyopathy (8 patients, 18.2%), and pulmonary hypertension (5 patients, 11.4%). In 31.8% of cases, cardiopulmonary arrest occurred within 30 min after initial symptoms. Frequent symptoms included pain (27.3%) and respiratory symptoms (27.3%), with 61.4% having initial symptoms during the prenatal period. 63.6% of the patients had known risk factors, with age ≥35 years (38.6%), hypertensive disorder (15.9%), and obesity (15.9%) being the most common. Quality of care was assessed as suboptimal in 16 (36.4%) patients. Cardiac risk assessment was insufficient in three patients with preexisting cardiac disease, while 13 patients had symptoms and risk factors warranting intensive monitoring and evaluation. CONCLUSION Aortic dissection was the leading cause of maternal death due to CVDs. Obstetrics care providers need to be familiar with cardiac risk factors and clinical warning signs that may lead to impending fatal cardiac events. Timely risk assessment, patient awareness, and a multidisciplinary team approach are key to improving maternal care in Japan.
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Affiliation(s)
- Tomomi Matsushita
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.,Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology, University of Miyazaki, Miyazaki, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan
| | - Takeshi Murakoshi
- Obstetrics and Gynecology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
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28
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Botti G, Thirunavukarasu S, Ziviello F, Chieffo A. Peripartum Cardiogenic Shock and Mechanical Circulatory Support. Interv Cardiol 2023; 18:e28. [PMID: 38213746 PMCID: PMC10782424 DOI: 10.15420/icr.2020.09] [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: 03/21/2020] [Accepted: 10/08/2023] [Indexed: 01/13/2024] Open
Abstract
Despite remarkable improvements in the past two decades, the annual cardiovascular mortality rate has remained higher for women than for men. Pregnant women represent an underinvestigated population in clinical research, and the mechanisms of long-term cardiovascular complications in women with obstetric complications remain to be elucidated. Regarding advanced heart failure during pregnancy, interventional approaches are effective but still underutilised. Percutaneous mechanical circulatory support is a valuable option for peripartum cardiogenic shock, although its use during pregnancy is still limited. Survival rates have improved in recent years, but further emphasis on the importance of early recognition and initiation of heart failure treatment in this patient group is warranted. The aims of this review are to summarise the current literature on the implementation of mechanical circulatory support in cardiogenic shock during pregnancy and delivery and to understand the role of percutaneous ventricular assist devices in the management of such conditions.
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Affiliation(s)
- Giulia Botti
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
- Vita Salute San Raffaele UniversityMilan, Italy
| | | | - Francesca Ziviello
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
- Vita Salute San Raffaele UniversityMilan, Italy
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29
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Roberts J, Afifi S. Spontaneous Dual Papillary Muscle Rupture in a Postpartum Patient with Ehlers-Danlos Syndrome. J Cardiothorac Vasc Anesth 2023; 37:2299-2304. [PMID: 37567804 DOI: 10.1053/j.jvca.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Jared Roberts
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Sherif Afifi
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL
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30
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Djokovic A, Krljanac G, Matic P, Zivic R, Djulejic V, Marjanovic Haljilji M, Popovic D, Filipovic B, Apostolovic S. Pathophysiology of spontaneous coronary artery dissection: hematoma, not thrombus. Front Cardiovasc Med 2023; 10:1260478. [PMID: 37928766 PMCID: PMC10623160 DOI: 10.3389/fcvm.2023.1260478] [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: 07/17/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) accounts for 1.7%-4% of all acute coronary syndrome presentations, particularly among young women with an emerging awareness of its importance. The demarcation of acute SCAD from coronary atherothrombosis and the proper therapeutic approach still represents a major clinical challenge. Certain arteriopathies and triggers are related to SCAD, with high variability in their prevalence, and often, the cause remains unknown. The objective of this review is to provide contemporary knowledge of the pathophysiology of SCAD and possible therapeutic solutions.
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Affiliation(s)
- Aleksandra Djokovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Predrag Matic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular Surgery, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
| | - Rastko Zivic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Surgery, Clinical Hospital Center Dr Dragisa Misovic “Dedinje”, BelgradeSerbia
| | - Vuk Djulejic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia
| | | | - Dusan Popovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Gastroenterology, Clinical Hospital Center Dr Dragisa Misovic “Dedinje”, BelgradeSerbia
| | - Branka Filipovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Gastroenterology, Clinical Hospital Center Dr Dragisa Misovic “Dedinje”, BelgradeSerbia
| | - Svetlana Apostolovic
- Coronary Care Unit, Cardiology Clinic, University Clinical Center of Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
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31
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720-3826. [PMID: 37622654 DOI: 10.1093/eurheartj/ehad191] [Citation(s) in RCA: 618] [Impact Index Per Article: 618.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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32
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Evans K, Wu P, Mamas MA, Irwin C, Kang P, Perlow JH, Foley M, Gulati M. Substance Use in Pregnancy and its Association With Cardiovascular Events. JACC. ADVANCES 2023; 2:100619. [PMID: 38938361 PMCID: PMC11198094 DOI: 10.1016/j.jacadv.2023.100619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 06/29/2024]
Abstract
Background Substance use and cardiovascular (CV) events are increasing among pregnant women in the United States, but association between substance use in pregnancy and CV events remains unknown. Objectives The purpose of this study was to examine the association between substance use and acute CV events in pregnancy. Methods We identified all women with a delivery hospitalization between 2004 and 2018 in the Nationwide Inpatient Sample, stratified on the presence or absence of substance use. The primary outcome was any acute CV event, defined as the presence of: acute myocardial infarction, stroke, arrhythmia, endocarditis, acute cardiomyopathy or heart failure, or cardiac arrest. Secondary outcomes were individual acute CV events, major adverse cardiac events, and maternal mortality. The association between substance use and outcomes were examined using multivariable logistical regression. Results A total of 60,014,368 delivery hospitalizations occurred from 2004 to 2018, with substance use complicating 955,531 (1.6%) deliveries. Substance use was independently associated with CV events (adjusted odds ratio [aOR]: 1.61; 95% CI: 1.53-1.70; P < 0.001), major adverse cardiac events (aOR: 1.53; 95% CI: 1.46-1.61; P < 0.001), and maternal mortality (aOR: 2.65; 95% CI: 2.15-3.25; P < 0.001) during delivery hospitalization. All individual substances had an increased association with CV events; however, amphetamine/methamphetamine had the strongest association (aOR: 2.71; 95% CI: 2.35-3.12; P < 0.001). All substances other than cocaine and cannabis had a significant association with maternal death. Conclusions Substance use has a strong association with acute CV events and maternal mortality during hospitalization for delivery and women with substance use warrant increased surveillance for CV events during this time.
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Affiliation(s)
- Kari Evans
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Pensée Wu
- Department of Cardiology, Keele University, Keele, United Kingdom
| | - Mamas A. Mamas
- Department of Cardiology, Keele University, Keele, United Kingdom
| | - Chase Irwin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Paul Kang
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Jordan H. Perlow
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Michael Foley
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arizona, Phoenix, Arizona, USA
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Mahabir S, Okumus N, Samra G, Mohammed A, Gupta M, Naser A, Puttur A, Bihler E, DuMont T, Nauer K, Khalif A, Ivanova V. Common Cardiovascular Diseases in Women. Crit Care Nurs Q 2023; 46:362-376. [PMID: 37684732 DOI: 10.1097/cnq.0000000000000473] [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: 09/10/2023]
Abstract
Cardiovascular disease is a leading cause of death for women in the United States. This article encompasses the epidemiology/etiology, clinical presentation, diagnostic assessment, management, and prognosis of some common cardiovascular disorders seen in women with a special focus on pregnancy.
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Affiliation(s)
- Sunita Mahabir
- Division of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania (Ms Mahabir and Drs Okumus, Samra, Mohammed, and Gupta); Division of Medicine (Drs Naser and Puttur), Division of Pulmonary and Critical Care Medicine (Drs Bihler and DuMont and Mr Nauer), Division of Cardiovascular Disease and Critical Care (Dr Khalif), and Division of Cardiovascular Medicine (Dr Ivanova), Allegheny Health Network Medicine Institute, Pittsburgh, Pennsylvania; and Drexel University College of Medicine, Philadelphia, Pennsylvania (Dr Ivanova)
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Androulakis E, Kourek C, Vrettos A, Kontopodis N, Lioudaki E, Prasinou M, Xanthopoulos A, Antonopoulos A, Briasoulis A, Mohiaddin R. Assessment of extra-coronary peripheral arteriopathy in spontaneous coronary dissection: state of the art in non-invasive imaging techniques and future perspectives. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad044. [PMID: 39045059 PMCID: PMC11195703 DOI: 10.1093/ehjimp/qyad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/19/2023] [Indexed: 07/25/2024]
Abstract
Spontaneous coronary artery dissection (SCAD) has been recognized as an important cause of acute coronary syndrome in women ≤ 50 years old, and up to 43% of pregnancy-associated myocardial infarction. SCAD has a strong association with extra-coronary arteriopathies, including either more common entities such as dissections, intracranial or other aneurysms, and extra-coronary and coronary arterial tortuosity or less common inherited vascular disorders such as Ehlers-Danlos syndrome, Marfan syndrome, and Loeys-Dietz syndrome, leading to the conclusion that systemic arterial disorders may underlie SCAD. Fibromuscular dysplasia is the most common extra-coronary vascular abnormality identified among these patients, also sharing a common genetic variant with SCAD. The American Heart Association, in a scientific statement regarding the management of SCAD, recommends that patients with SCAD should undergo additional evaluation with imaging techniques including either computed tomography angiography (CTA) or magnetic resonance angiography (MRA). MRA has been shown to have sufficient diagnostic accuracy in identifying extra-coronary arterial abnormalities, almost equal to CTA and conventional angiography. The aim of this review is to appraise the most recent important evidence of extra-coronary arteriopathy in the setting of SCAD and to discuss the strengths and weaknesses of various non-invasive imaging methods for screening of extra-coronary arteriopathies in patients with SCAD.
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Affiliation(s)
- Emmanuel Androulakis
- Inherited Cardiac Conditions Department, St George's University Hospital, Blackshaw Rd, London SW17 0QT, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, National and Heart Lung Institute, Imperial College London, Sydney St, London SW3 6NP, UK
| | - Christos Kourek
- Department of Cardiology, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eirini Lioudaki
- Renal Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Maria Prasinou
- Department of Immunology, Royal Free London NHS Trust, London, UK
| | | | - Alexios Antonopoulos
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Briasoulis
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Raad Mohiaddin
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, National and Heart Lung Institute, Imperial College London, Sydney St, London SW3 6NP, UK
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Mantel Ä, Sandström A, Faxén J, Andersson DC, Razaz N, Cnattingius S, Stephansson O. Pregnancy-Induced Hypertensive Disorder and Risks of Future Ischemic and Nonischemic Heart Failure. JACC. HEART FAILURE 2023; 11:1216-1228. [PMID: 37178088 DOI: 10.1016/j.jchf.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/31/2023] [Accepted: 03/24/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Although adverse pregnancy outcomes are associated with an increased risk of cardiovascular disease, studies on timing and subtypes of heart failure after a hypertensive pregnancy are lacking. OBJECTIVES The goal of this study was to assess the association between pregnancy-induced hypertensive disorder and risk of heart failure, according to ischemic and nonischemic subtypes, and the impact of disease characteristics and the timing of heart failure risks. METHODS This was a population-based matched cohort study, comprising all primiparous women without a history of cardiovascular disease included in the Swedish Medical Birth Register between 1988 and 2019. Women with pregnancy-induced hypertensive disorder were matched with women with normotensive pregnancies. Through linkage with health care registers, all women were followed up for incident heart failure, classified as ischemic or nonischemic. RESULTS In total, 79,334 women with pregnancy-induced hypertensive disorder were matched with 396,531 women with normotensive pregnancies. During a median follow-up of 13 years, rates of all heart failure subtypes were more common among women with pregnancy-induced hypertensive disorder. Compared with women with normotensive pregnancies, adjusted HRs (aHRs) with 95% CIs were as follows: heart failure overall, aHR: 1.70 (95% CI: 1.51-1.91); ischemic heart failure, aHR: 2.28 (95% CI: 1.74-2.98); and nonischemic heart failure, aHR: 1.60 (95% CI: 1.40-1.83). Disease characteristics indicating severe hypertensive disorder were associated with higher heart failure rates, and rates were highest within the first years after the hypertensive pregnancy but remained significantly increased thereafter. CONCLUSIONS Pregnancy-induced hypertensive disorder is associated with an increased short-term and long-term risk of incident ischemic and nonischemic heart failure. Disease characteristics indicating more severe forms of pregnancy-induced hypertensive disorder amplify the heart failure risks.
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Affiliation(s)
- Ängla Mantel
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden; Theme Women's Health, Department of Obstetrics, Karolinska University Hospital, Stockholm, Sweden.
| | - Anna Sandström
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden; Theme Women's Health, Department of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Faxén
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Daniel C Andersson
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Neda Razaz
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden
| | - Sven Cnattingius
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden
| | - Olof Stephansson
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden; Theme Women's Health, Department of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
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Oliveira GMMD, Almeida MCCD, Rassi DDC, Bragança ÉOV, Moura LZ, Arrais M, Campos MDSB, Lemke VG, Avila WS, Lucena AJGD, Almeida ALCD, Brandão AA, Ferreira ADDA, Biolo A, Macedo AVS, Falcão BDAA, Polanczyk CA, Lantieri CJB, Marques-Santos C, Freire CMV, Pellegrini D, Alexandre ERG, Braga FGM, Oliveira FMFD, Cintra FD, Costa IBSDS, Silva JSN, Carreira LTF, Magalhães LBNC, Matos LDNJD, Assad MHV, Barbosa MM, Silva MGD, Rivera MAM, Izar MCDO, Costa MENC, Paiva MSMDO, Castro MLD, Uellendahl M, Oliveira Junior MTD, Souza OFD, Costa RAD, Coutinho RQ, Silva SCTFD, Martins SM, Brandão SCS, Buglia S, Barbosa TMJDU, Nascimento TAD, Vieira T, Campagnucci VP, Chagas ACP. Position Statement on Ischemic Heart Disease - Women-Centered Health Care - 2023. Arq Bras Cardiol 2023; 120:e20230303. [PMID: 37556656 PMCID: PMC10382148 DOI: 10.36660/abc.20230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | | | | | - Celi Marques-Santos
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brasil
| | | | - Denise Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | - Fabiana Goulart Marcondes Braga
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Lara Terra F Carreira
- Cardiologia Nuclear de Curitiba, Curitiba, PR - Brasil
- Hospital Pilar, Curitiba, PR - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Marly Uellendahl
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
- DASA - Diagnósticos da América S/A, São Paulo, SP - Brasil
| | - Mucio Tavares de Oliveira Junior
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | - Ricardo Quental Coutinho
- Faculdade de Ciências Médicas da Universidade de Pernambuco (UPE), Recife, PE - Brasil
- Hospital Universitário Osvaldo Cruz da Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | | | - Sílvia Marinho Martins
- Pronto Socorro Cardiológico de Pernambuco da Universidade de Pernambuco (PROCAPE/UPE), Recife, PE - Brasil
| | | | - Susimeire Buglia
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Thais Vieira
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Rede D'Or, Aracaju, SE - Brasil
- Hospital Universitário da Universidade Federal de Sergipe (UFS), Aracaju, SE - Brasil
| | | | - Antonio Carlos Palandri Chagas
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Centro Universitário Faculdade de Medicina ABC, Santo André, SP - Brasil
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37
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Hogea T, Suciu BA, Chinezu L, Brinzaniuc K, Arbănași EM, Ungureanu A, Kaller R, Carașca C, Arbănași EM, Vunvulea V, Hălmaciu I, Mureșan AV, Russu E, Ciucanu CC, Radu CM, Radu CC. Pregnancy-Associated Spontaneous Coronary Acute Dissection as a Cause of Sudden Cardiac Death-Autopsy Findings and Literature Review: Is COVID-19 Related? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1257. [PMID: 37512074 PMCID: PMC10386237 DOI: 10.3390/medicina59071257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/25/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
Sudden cardiac death (SCD) is the leading cause of mortality globally (violent or non-violent), with few to no feasible remedies. The etiopathogenesis of SCD involves a complex and multilayered substrate in which dynamic factors interact with a preexistent cardiovascular pathology, which is often undiagnosed and untreated, leading to the rapid development of cardiac rhythm disorders and cardiac arrest. Cardiovascular disease is a rare but emerging factor in maternal mortality that can be justified by an upward trend in the mean age of pregnant individuals. Spontaneous coronary artery dissection (SCAD) is defined as a non-traumatic and non-iatrogenic separation of the coronary arterial wall by intramural hemorrhage with or without an intimal tear. The resulting intramural hematoma compresses the coronary arteries, reducing blood flow and causing myocardial ischemia. SCAD continues to be misdiagnosed, underdiagnosed, and managed as an atherosclerotic acute coronary syndrome, which may harm patients with SCAD. The latest research shows that individuals who have or have had coronavirus disease 2019 (COVID-19) may also present coagulation abnormalities, so infection with COVID-19 during pregnancy can increase this hypercoagulable condition, thus increasing the risk of SCAD and SCD. This present study reports two cases over 35 years, one being infected with SARS-COV2 one month before the event and the other being tested positive during admission, both asymptomatic, who were declared healthy on periodic clinical evaluations, with pregnancies over 35 weeks, with normal fetal development, which suddenly caused chest pain, dyspnea, and loss of consciousness, required emergency c-sections, and died suddenly after they were performed. In both cases, the cause of death was SCAD on the anterior-descending artery. In both cases, emergency percutaneous coronary intervention was performed. The second part of the study represents a literature overview of SCAD during COVID-19. In addition to pregnancy hormonal changes, other potential hormone-mediated SCAD triggers are still under discussion.
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Affiliation(s)
- Timur Hogea
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Institute of Forensic Medicine, 540141 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Bogdan Andrei Suciu
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Laura Chinezu
- Institute of Forensic Medicine, 540141 Targu Mures, Romania
- Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Klara Brinzaniuc
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Emil Marian Arbănași
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Ancuța Ungureanu
- Epidemiology Clinic, Mures County Hospital, 540072 Targu Mures, Romania
| | - Réka Kaller
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Cosmin Carașca
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Institute of Forensic Medicine, 540141 Targu Mures, Romania
| | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Vlad Vunvulea
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Ioana Hălmaciu
- Institute of Forensic Medicine, 540141 Targu Mures, Romania
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | | | - Casandra Maria Radu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania
| | - Carmen Corina Radu
- Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
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38
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Kim CW, Frishman WH, Aronow WS. Spontaneous Coronary Artery Dissection: Review of Possible Pathophysiological Risk Factors. Cardiol Rev 2023; 31:207-214. [PMID: 36288472 DOI: 10.1097/crd.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS) that typically affects the younger and healthier female population without the typical ACS risk factors such as hypertension, diabetes, or hyperlipidemia. The clinical presentation of SCAD can be diverse and the diagnosis is typically by coronary angiography but also can require advanced imaging such as intravascular ultrasound or optical coherence tomography. Past studies have shown the atypical patient characteristics of SCAD patients among ACS patients. The main challenge is that the exact pathophysiology of SCAD is unknown. Potential pathophysiological risk factors are discussed including fibromuscular dysplasia, other arteriopathies, pregnancy and female sex hormone changes, migraines, inflammatory conditions, and stress. The current understanding of these risk factors along with potential pathophysiological mechanisms are discussed. There still remain many areas of additional investigation in understanding this rare cause of ACS.
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Affiliation(s)
- Chan W Kim
- From the Cardiology Division, and the Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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39
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Kuehnemund L, Lange SA, Feld J, Padberg JS, Fischer AJ, Makowski L, Engelbertz C, Dröge P, Ruhnke T, Guenster C, Gerß J, Freisinger E, Reinecke H, Koeppe J. Sex disparities in guideline-recommended therapies and outcomes after ST-elevation myocardial infarction in a contemporary nationwide cohort of patients over an eight-year period. Atherosclerosis 2023; 375:30-37. [PMID: 37245424 DOI: 10.1016/j.atherosclerosis.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIMS Acute myocardial infarction (AMI) is the leading cause of death worldwide. Outcome has improved during the last decades due to secondary prevention and widespread coronary interventions, but recent studies still show sex differences and insufficient drug adherence. We aimed to determine differences in the treatment strategies and outcomes between women and men with ST-elevation myocardial infarction (STEMI) in Germany. METHODS From the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskrankenkasse), 175,187 patients were identified who were hospitalized due to STEMI in Germany between January 1, 2010 and December 31, 2017. RESULTS Compared to men, women were older (median 76 vs. 64 years) and had more often diabetes, hypertension, chronic heart failure, and chronic kidney disease (all p <0.001). Women suffered from higher rates of in-hospital complications such as bleeding (9.3 vs. 6.6%), longer hospitalizations (12.2 vs. 11.7 days) and were less likely to undergo percutaneous coronary intervention (75.5 vs. 85.2%). After adjustment for patient's risk profile, female sex was associated with decreased overall survival (HR 1.02, 95% confidence interval (CI) 1.00-1.04; p=0.036). Notably, more men received all four guideline-recommended drugs after STEMI (women 65.7% vs. men 69.8% after 90 days; p <0.001). With increasing number of prescribed drugs, patients benefit even more. This concerned both sexes, but was more pronounced in men (with 4 prescribed drugs: women HR 0.52, 95%CI 0.50-0.55; men HR 0.48, 95% CI 0.47-0.50, pint = 0.014). CONCLUSIONS In a contemporary nationwide analysis, women with STEMI were older, had more comorbidities, underwent revascularization less often and had an increased risk for major complications as well as overall survival. Guideline-recommended drug therapy was applied less frequently in women although associated with an improved overall-survival.
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Affiliation(s)
- Leonie Kuehnemund
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Stefan A Lange
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany.
| | - Jannik Feld
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - Jan-Soeren Padberg
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Alicia J Fischer
- University Hospital Muenster, Cardiol., Dept. of Cardiology III - Adult Congenital and Valvular Heart Disease, Muenster, Germany
| | - Lena Makowski
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Christiane Engelbertz
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | | | | | | | - Joachim Gerß
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - Eva Freisinger
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Holger Reinecke
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Jeanette Koeppe
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
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40
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Wahinya M, Ngunjiri MM, Khan Z. Spontaneous Coronary Arterial Dissection in a Young Female in the Postpartum Period: A Case Report From Sub-Saharan Africa. Cureus 2023; 15:e39507. [PMID: 37378180 PMCID: PMC10291357 DOI: 10.7759/cureus.39507] [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] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Spontaneous coronary arterial dissection (SCAD) has become an important cause of acute coronary syndrome (ACS) and sudden cardiac death, particularly in young women, without classic atherosclerotic cardiovascular risk factors. Missed diagnosis is common due to a low index of suspicion in these patients. Here, we present a case of a 29-year-old African female in the postpartum period who presented with a two-week history of heart failure symptoms and acute onset chest pain. An electrocardiogram showed ST-segment elevation myocardial infarction (STEMI) with elevated high-sensitivity troponin T. Echocardiography on admission revealed an ejection fraction of 40% with septal hypokinesia. Coronary angiography showed multivessel dissection with type 1 SCAD in the left circumflex artery and type 2 SCAD in the left anterior descending artery. The patient was managed conservatively, and angiographic healing of SCAD together with normalization of the left ventricular systolic dysfunction was seen after four months. SCAD should always be in the differential diagnosis of any peripartum patient who presents with ACS and lacks the typical atherosclerotic risk factors. Accurate diagnosis and appropriate management are paramount in such cases.
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Affiliation(s)
- Maureen Wahinya
- Internal Medicine, Kenyatta University Teaching, Referral and Research Hospital, Nairobi, KEN
| | - Morgan M Ngunjiri
- Internal Medicine, Kenyatta University Teaching, Referral and Research Hospital, Nairobi, KEN
| | - Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
- Cardiology, Barts Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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41
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Smirnova A, Aliberti F, Cavaliere C, Gatti I, Vilardo V, Giorgianni C, Cassani C, Repetto A, Narula N, Giuliani L, Urtis M, Ozaki Y, Prati F, Arbustini E, Ferrari M. Spontaneous coronary artery dissection: an unpredictable event. Eur Heart J Suppl 2023; 25:B7-B11. [PMID: 37091648 PMCID: PMC10120938 DOI: 10.1093/eurheartjsupp/suad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of acute coronary syndrome that predominantly affects women in adulthood and is the leading cause of acute myocardial infarction in pregnancy. The most common clinical presentation is ST-segment elevation myocardial infarction (STEMI) or non-STEMI, followed by cardiogenic shock (∼2%), sudden cardiac death (0.8% in autopsy series), cardiac arrest, ventricular arrhythmias (∼5%), and Takotsubo syndrome. The prevalence of SCAD in the general population is largely uncertain due to underdiagnosis. Oral contraceptives, post-menopausal therapy, and infertility treatments are recognized associated factors. The pathological substrates (fibromuscular dysplasia) and triggers (especially emotional stress) are commonly present in affected women. The few cases with a precise genetic aetiology occur in the context of syndromic and non-syndromic connective tissue diseases. The only true certainty in SCAD is the overwhelming prevalence in women. The first event as well as the recurrence (up to 30%, which varies depending on the definition) is largely unpredictable. The treatment strategy is highly individualized and requires extensive additional study in order to optimize outcomes and prevent major adverse cardiovascular events in affected individuals. We have known about SCAD for nearly a century, but we still do not know how best to prevent, diagnose, and treat it, making SCAD a highly important and unmet clinical need.
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Affiliation(s)
- Alexandra Smirnova
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Flaminia Aliberti
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudia Cavaliere
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Gatti
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Viviana Vilardo
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carmelina Giorgianni
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Obstetrics and Gynecology, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Alessandra Repetto
- Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Nupoor Narula
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Lorenzo Giuliani
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mario Urtis
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Francesco Prati
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
- Centro per la Lotta Contro L’Infarto—CLI Foundation, Rome, Italy
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42
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Chokhachi R, Reiss CK. The role of coronary computed tomography angiography in pregnancy-associated myocardial infarction. Oxf Med Case Reports 2023; 2023:omad041. [PMID: 37091686 PMCID: PMC10120434 DOI: 10.1093/omcr/omad041] [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: 07/17/2022] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
Background Pregnancy-associated coronary artery dissection is one of the critical causes of myocardial infarction in young females. The challenges in the diagnosis and follow-up of pregnancy-associated myocardial infarction prompted us to highlight the potential role of coronary computed angiography in managing this life-threatening medical condition. Case Summary We describe a case of a 29-year-old female with sudden onset chest discomfort one-week postpartum. She presented to the hospital with an ST-elevation myocardial infarction and was urgently taken to the cath lab for PCI and stent placement. Thirteen months later, with intermittent chest discomfort, an coronary computed tomography was done, demonstrating evidence of SCAD and aneurysm formation in the left main coronary artery and left circumflex coronary artery. Repeat cardiac catheterization confirmed the same diagnosis. Given her refractory chest discomfort and the chance of aneurysm rupture decision was made to proceed with a three-vessel CABG. At 3-month and 1-year followup visits, the patient is doing well and remains pain-free. Conclusion In this case presentation, we aim to highlight the potential role of Coronary Computed tomography angiography in the diagnosis and follow-up of pregnancy-associated spontaneous coronary artery dissection, given the high accuracy and non invasiveness of this diagnostic modality in the context of the high prevalence of spontaneous coronary artery dissection in symptomatic or asymptomatic pregnancy-associated myocardial infarction.
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Affiliation(s)
- Reihaneh Chokhachi
- Correspondence address. St. Luke’s Hospital, Internal Medicine GME office, 224 S. Woods Mill Road, Suite 400 South, Chesterfield, MO, USA 63017. E-mail:
| | - Craig K Reiss
- Department of Cardiology, St. Luke's Hospital, Chesterfield, MO, USA
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43
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Thakkar A, Hameed AB, Makshood M, Gudenkauf B, Creanga AA, Malhamé I, Grandi SM, Thorne SA, D'Souza R, Sharma G. Assessment and Prediction of Cardiovascular Contributions to Severe Maternal Morbidity. JACC. ADVANCES 2023; 2:100275. [PMID: 37560021 PMCID: PMC10410605 DOI: 10.1016/j.jacadv.2023.100275] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 08/11/2023]
Abstract
Severe maternal morbidity (SMM) refers to any unexpected outcome directly related to pregnancy and childbirth that results in both short-term delivery complications and long-term consequences to a women's health. This affects about 60,000 women annually in the United States. Cardiovascular contributions to SMM including cardiac arrest, arrhythmia, and acute myocardial infarction are on the rise, probably driven by changing demographics of the pregnant population including more women of extreme maternal age and an increased prevalence of cardiometabolic and structural heart disease. The utilization of SMM prediction tools and risk scores specific to cardiovascular disease in pregnancy has helped with risk stratification. Furthermore, health system data monitoring and reporting to identify and assess etiologies of cardiovascular complications has led to improvement in outcomes and greater standardization of care for mothers with cardiovascular disease. Improving cardiovascular disease-related SMM relies on a multipronged approach comprised of patient-level identification of risk factors, individualized review of SMM cases, and validation of risk stratification tools and system-wide improvements in quality of care. In this article, we review the epidemiology and cardiac causes of SMM, we provide a framework of risk prediction clinical tools, and we highlight need for organization of care to improve outcomes.
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Affiliation(s)
- Aarti Thakkar
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Afshan B. Hameed
- Department of Obstetrics & Gynecology, Department of Medicine, University of California-Irvine, Irvine, California, USA
| | - Minhal Makshood
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brent Gudenkauf
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreea A. Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Isabelle Malhamé
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sonia M. Grandi
- Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara A. Thorne
- Division of Cardiology, Pregnancy & Heart Disease Program, Mount Sinai Hospital & University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Departments of Obstetrics & Gynaecology and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Tapaskar N, Tremblay-Gravel M, Khush KK. Contemporary Management of Cardiogenic Shock During Pregnancy. J Card Fail 2023; 29:193-209. [PMID: 36243342 DOI: 10.1016/j.cardfail.2022.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
Cardiogenic shock is the most extreme cardiovascular disease state during pregnancy. Peripartum cardiomyopathy is the most common cause of cardiogenic shock toward the end of pregnancy and in the early postpartum period. Therapy for cardiogenic shock relies on appropriate phenotyping of shock etiology, severity and ventricular predominance, which are critical in the appropriate selection of medical and mechanical therapy. Mechanical circulatory support may be used as a bridge to recovery or as definitive therapy. Intra-aortic balloon pumps, percutaneous left ventricular assist devices and venoarterial extracorporeal circulatory devices have been successfully used in pregnancy and the postpartum period. The most commonly used mechanical therapy in the pregnant patient is extracorporeal membranous oxygenation circulatory support. The use of mechanical circulatory devices in peripartum cardiomyopathy has contributed to improved survival rates in recent years. Further efforts to identify the optimal mechanical circulatory support strategy for peripartum cardiomyopathy and cardiogenic shock in the peripartum period are needed.
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Affiliation(s)
- Natalie Tapaskar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
| | | | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
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Yabut AG, Bachar B, Nagm H. Coronary Artery Bypass Graft Surgery for Spontaneous Coronary Artery Dissection in Early Pregnancy: Medical and Ethical Decision-Making Issues. Cureus 2023; 15:e35364. [PMID: 36851947 PMCID: PMC9958203 DOI: 10.7759/cureus.35364] [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] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) in young females is a rare condition that typically occurs during the postpartum period.Even more rare is when SCAD occurs during the antepartum phase of pregnancy. This scenario can have catastrophic outcomes for both the mother and the unborn child. Due to its infrequency, there is minimal information on how to treat these patients effectively while keeping both the mother and the unborn child as safe as possible. We present a case of a 36-year-old multiparous Caucasian female brought in by an ambulance for sudden-onset left-sided chest pain radiating to her left shoulder, arm, and back. The initial laboratory tests were significant for a B-type natriuretic peptide (BNP) level of 190.82 pg/mL (the normal range is less than 100 pg/mL) and a troponin level of 3.98 ng/mL (the normal range is less than 0.04 ng/mL), which peaked to 18.39 ng/mL in less than 24 hours. Electrocardiogram (EKG) showed sinus tachycardia of 103 beats per minute (bpm) and anterolateral ST-T changes suggestive of ischemia. Human chorionic gonadotropin (hCG) was 32 mIU/mL (the normal range is less than 5 mIU/mL), which may indicate early pregnancy. Echocardiogram (ECHO) showed left anterior descending (LAD) artery territory wall motion abnormalities, which included the akinesis of the apical, middle, and apical anterior septum and the hypokinesis of the basal anteroseptal segment. Her calculated ejection fraction was 38.4% with no valvular abnormalities. Cardiac catheterization showed severe diffuse LAD disease in the proximal segment with the middle LAD and diagonal branch subtotally occluded. The right coronary artery (RCA) had severe disease. Cardiothoracic surgery was consulted for a coronary artery bypass graft (CABG). The procedure performed was a three-vessel coronary artery bypass graft, which included the following: left internal mammary artery (LIMA) to middle LAD, saphenous vein graft (SVG) to distal LAD, and SVG to diagonal. This case report aims to provide additional information to the database of SCAD in pregnant females undergoing coronary artery bypass graft surgery.
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Affiliation(s)
- Adrian G Yabut
- Anesthesiology, Kaweah Health Medical Center, Visalia, USA
| | - Bradlee Bachar
- Cardiothoracic Anesthesiology, Kaweah Health Medical Center, Visalia, USA
| | - Hussam Nagm
- Cardiothoracic Anesthesiology, Kaweah Health Medical Center, Visalia, USA
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Sawyer JM, Moridzadeh N, Bavolek RA. Cardiovascular Complications of Pregnancy. Emerg Med Clin North Am 2023; 41:247-258. [PMID: 37024161 DOI: 10.1016/j.emc.2023.01.005] [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: 02/22/2023]
Abstract
The physiologic changes in pregnancy predispose the pregnant patient to a variety of potential cardiovascular complications. In this article, we discuss the major cardiovascular disorders of pregnancy and their management, highlight specific diagnostic challenges, and discuss new developments in the field. Topics covered in this article include venous thromboembolism, acute myocardial infarction, peripartum cardiomyopathy, and aortic dissection.
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Affiliation(s)
- John Mark Sawyer
- UCLA Ronald Reagan, Olive View Emergency Medicine Residency, 1100 Glendon Avenue, Suite 1200, Los Angeles, CA 90024, USA.
| | | | - Rebecca A Bavolek
- UCLA Ronald Reagan, Olive View Emergency Medicine Residency, 1100 Glendon Avenue, Suite 1200, Los Angeles, CA 90024, USA
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Lucà F, Colivicchi F, Parrini I, Russo MG, Di Fusco SA, Ceravolo R, Riccio C, Favilli S, Rossini R, Gelsomino S, Oliva F, Gulizia MM. The role of the pregnancy heart team in clinical practice. Front Cardiovasc Med 2023; 10:1135294. [PMID: 37139137 PMCID: PMC10150137 DOI: 10.3389/fcvm.2023.1135294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Significant maternal and fetal morbidity and mortality risk has been shown to be associated with cardiovascular disease in pregnancy. Several determinants, such as the increasing number of females with corrected congenital heart disease in reproductive age, a more advanced maternal age associated with cardiovascular risk factors, and a greater prevalence of preexisting comorbidities related to cardiac disorders such as cancer and COVID-19), lead to a higher incidence of cardiac complications in pregnancy in the last few decades. However, adopting a multidisciplinary strategy may influence maternal and neonatal outcomes. This review aims at assessing the role of the Pregnancy Heart Team, which should ensure careful pre-pregnancy counseling, pregnancy monitoring, and delivery planning for both congenital and other cardiac or metabolic disorders, addressing several emerging aspects in the multidisciplinary team-based approach.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, Reggio Calabria, Italy
- Correspondence: Fabiana Lucà
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, Roma, Italy
| | - Iris Parrini
- Cardiology Department, Mauriziano Hospital, Torino, Italy
| | - Maria Giovanna Russo
- U.O.C. Cardiologia e UTIC Pediatrica, AORN dei Colli, Ospedale Monaldi, Università Della Campania “L. Vanvitelli”, Napoli, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, Roma, Italy
| | | | - Carmine Riccio
- Cardiovascular Department, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | - Silvia Favilli
- Department of Pediatric Cardiology, Meyer Hospital, Florence, Italy
| | | | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, Netherlands
| | - Fabrizio Oliva
- Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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Abstract
Spontaneous coronary artery dissection (SCAD) is a significant cause of myocardial infarction (MI) and is more prevalent in pregnancy. The disease is being increasingly appreciated and diagnosed with the development and application of coronary angiography and intravascular imaging. Recurrent spontaneous coronary artery dissection (R-SCAD) is relatively common, with recurrence rates ranging from 8 to 27%. R-SCAD usually involves anatomical sites different from the original SCAD lesion and can cause MI, ventricular arrhythmias, and cardiogenic shock. This study aims to conduct a comprehensive review of R-SCAD to identify early risk factors and guide prevention policies and interventions. In addition, the risk of R-SCAD in subsequent pregnancies in women with a history of SCAD is discussed.
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Thromboembolic Events in Patients with Influenza: A Scoping Review. Viruses 2022; 14:v14122817. [PMID: 36560821 PMCID: PMC9785394 DOI: 10.3390/v14122817] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Influenza is an acute respiratory infection that usually causes a short-term and self-limiting illness. However, in high-risk populations, this can lead to several complications, with an increase in mortality. Aside from the well-known extrapulmonary complications, several studies have investigated the relationship between influenza and acute cardio and cerebrovascular events. Reviews of the thromboembolic complications associated with influenza are lacking. OBJECTIVES the study aims to conduct a scoping review to analyze the epidemiological and clinical characteristics of patients suffering from influenza and thromboembolic complications. MATERIALS AND METHODS A computerized search of historical published cases using PubMed and the terms "influenza" or "flu" and "thrombosis", "embolism", "thromboembolism", "stroke", or "infarct" for the last twenty-five years was conducted. Only articles reporting detailed data on patients with thromboembolic complications of laboratory-confirmed influenza were considered eligible for inclusion in the scoping review. RESULTS Fifty-eight cases with laboratory documented influenza A or B and a related intravascular thrombosis were retrieved. Their characteristics were analyzed along with those of a patient who motivated our search. The localizations of thromboembolic events were pulmonary embolism 21/58 (36.2%), DVT 12/58 (20.6%), DVT and pulmonary embolism 3/58 (5.1%), acute ischemic stroke 11/58 (18.9%), arterial thrombosis 4/58 (6.8%), and acute myocardial infarction 5/58 (8.6%). DISCUSSION Our findings are important in clarifying which thromboembolic complications are more frequent in adults and children with influenza. Symptoms of pulmonary embolism and influenza can be very similar, so a careful clinical evaluation is required for proper patient management, possible instrumental deepening, and appropriate pharmacological interventions, especially for patients with respiratory failure.
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Muacevic A, Adler JR, Mustafa A, Tabet R, Lafferty JC. A Case of Peripartum Spontaneous Coronary Artery Dissection in a Woman With a History of Obesity. Cureus 2022; 14:e33021. [PMID: 36721534 PMCID: PMC9880137 DOI: 10.7759/cureus.33021] [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] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS) with a high prevalence in young pregnant females. A 38-year-old female with a history of morbid obesity status post-bariatric surgery presented with chest pain. The electrocardiogram (EKG) revealed ST-segment elevation in the inferior leads as well as slightly elevated troponin. Urgent cardiac catheterization showed SCAD, and she was subsequently managed with medical therapy. We hypothesize that the history of obesity leads to a compromise in the coronary vasculature, thereby predisposing the patient to SCAD.
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