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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 We present a literature review of SCAD, and we report an unpublished case of SCAD in a COVID-19 patient.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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Roy AK, Roy M, Yadav M, Potu KC, Mungee S. Spontaneous coronary artery dissection, a commonly overlooked etiology of acute coronary syndrome. J Community Hosp Intern Med Perspect 2020; 10:318-323. [PMID: 32850088 PMCID: PMC7427437 DOI: 10.1080/20009666.2020.1781029] [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] [Indexed: 12/04/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a type of non-atherosclerotic coronary artery disease, initially thought to be uncommon but is now being increasingly recognized as a cause of acute coronary syndrome in females. The exact incidence of this remains unknown and most of these cases undergo emergent percutaneous intervention (PCI) due to concern for acute coronary syndrome (ACS). Prior studies have shown that PCI can be detrimental in these cases. It is important to recognize the possibility of SCAD in young female patients so that potentially harmful interventions, such as starting these patients immediately on heparin, use of thrombolytic therapy, and emergent PCI that can lead to worse outcomes, are avoided.
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Affiliation(s)
- Ashish Kumar Roy
- Department of Internal Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Moni Roy
- Department of Internal Medicine, University of Illinois College of Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Manajyoti Yadav
- Department of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Kalyan C Potu
- Department of Cardiology, Southern Illinois University, Springfield, IL, USA
| | - Sudhir Mungee
- Department of Cardiology, University of Illinois College of Medicine, Peoria, IL, USA
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Ghafoor HU, Bose A, El-Meligy A, Hannan J. A case report of recurrent spontaneous coronary artery dissection and Takotsubo cardiomyopathy: a treatment dilemma. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 32128501 PMCID: PMC7047070 DOI: 10.1093/ehjcr/ytaa004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/17/2019] [Accepted: 01/10/2020] [Indexed: 12/23/2022]
Abstract
Background Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome in younger females with no pre-existing history of coronary artery disease. Recurrent SCAD is common after a first episode and can involve the same coronary artery or present as a new dissection unrelated to the initial lesion. Current recommendations advise for a conservative approach in the absence of haemodynamic compromise and flow limitations. Conversely, there are no clear guidelines for the management of early recurrent SCAD. Case summary A 52-year-old woman with history of obesity, asthma, and prediabetes presented with chest pain and electrocardiogram (ECG) showing inferior wall ST-elevation myocardial infarction (STEMI). Coronary angiography revealed proximal right coronary artery (RCA) dissection and distal left anterior descending artery (LAD) dissection, while left ventriculogram showed Takotsubo cardiomyopathy (TC). Angiography revealed no flow limitations so conservative management was pursued. She returned within a couple of days with recurrent chest pain and ECG showing similar findings of inferior STEMI. Repeat angiography confirmed progression of the proximal RCA SCAD with resolution of distal LAD SCAD. Since flow through the distal RCA was still preserved, conservative medical management was continued. She presented a third time for palpitations only and another repeat coronary angiogram showed healing RCA SCAD. Discussion Management of early recurrent SCAD continues to be a clinical dilemma. In addition, our patient had features of TC which shares a similar clinical risk factor profile with SCAD thus it may be prudent to further investigate for TC in patients presenting with SCAD and have suggestive features of TC on history and echocardiography.
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Affiliation(s)
- Hafiz U Ghafoor
- Division of Cardiology, Department of Internal Medicine, Saint Vincent Hospital, University of Massachusetts School of Medicine, 123 Summer Street, Worcester, MA 01608, USA
- Corresponding author. Tel: +1 508 363 6162, Fax: +1 508 363 6225,
| | - Abhishek Bose
- Division of Cardiology, Department of Internal Medicine, Saint Vincent Hospital, University of Massachusetts School of Medicine, 123 Summer Street, Worcester, MA 01608, USA
| | - Amr El-Meligy
- Division of Cardiology, Department of Internal Medicine, Saint Vincent Hospital, University of Massachusetts School of Medicine, 123 Summer Street, Worcester, MA 01608, USA
| | - Joseph Hannan
- Division of Cardiology, Department of Internal Medicine, Saint Vincent Hospital, University of Massachusetts School of Medicine, 123 Summer Street, Worcester, MA 01608, USA
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Y-Hassan S, Henareh L. Fibrinolysis-treated myocardial infarction in a patient with missed spontaneous coronary artery dissection associated with takotsubo syndrome: case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 2:yty145. [PMID: 31020220 PMCID: PMC6426041 DOI: 10.1093/ehjcr/yty145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/11/2018] [Indexed: 01/30/2023]
Abstract
Background Spontaneous coronary artery dissection (SCAD) is an under-recognized acute cardiac disease entity. It is often missed, or misdiagnosed as coronary spasm, coronary atherosclerotic lesion, or thrombotic coronary occlusion. During the last years, SCAD also has been reported to be 'misdiagnosed as takotsubo syndrome (TS)' in patients with features consistent with both conditions. Spontaneous coronary artery dissection may present as an acute coronary syndrome and sometimes as sudden cardiac death. Case summary We report on the case of a 67-year-old woman who presented with features of ST-elevation myocardial infarction treated with fibrinolysis. The patient showed to have obtuse-marginal SCAD, which was misdiagnosed as fibrinolysis caused lysis of a coronary thrombus. The patient had moreover all other features of TS. Discussion This case report teaches important information about SCAD. The association between SCAD and TS are discussed.
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Affiliation(s)
- Shams Y-Hassan
- Coronary and Vascular Heart Disease, Heart and Vascular Theme, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Loghman Henareh
- Coronary and Vascular Heart Disease, Heart and Vascular Theme, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Macaya F, Salinas P, Gonzalo N, Fernández-Ortiz A, Macaya C, Escaned J. Spontaneous coronary artery dissection: contemporary aspects of diagnosis and patient management. Open Heart 2018; 5:e000884. [PMID: 30487978 PMCID: PMC6241978 DOI: 10.1136/openhrt-2018-000884] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 02/06/2023] Open
Abstract
Spontaneous coronary artery dissection is an increasingly recognised cause of acute coronary syndromes, especially in young and middle-age women. Recognising its particularities and differences with atherosclerotic disease is central for appropriately identifying and approaching these patients. The authors review the current state of knowledge on spontaneous coronary artery dissection and provide practical recommendations for the diagnosis and management of this condition, both in the acute and convalescence phases.
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Affiliation(s)
- Fernando Macaya
- Servicio de Cardiología, Hospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
| | - Pablo Salinas
- Servicio de Cardiología, Hospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
| | - Nieves Gonzalo
- Servicio de Cardiología, Hospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Servicio de Cardiología, Hospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
| | - Carlos Macaya
- Servicio de Cardiología, Hospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
| | - Javier Escaned
- Servicio de Cardiología, Hospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
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Y-Hassan S. Spontaneous coronary artery dissection and takotsubo syndrome: An often overlooked association; review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:717-723. [PMID: 29502960 DOI: 10.1016/j.carrev.2018.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 12/30/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) and takotsubo syndrome (TS) are two cardiovascular syndromes with predilection for women. Both conditions may be preceded by an emotional stress or, for the affected individual, an unusual severe physical exercise. "Restitution ad integrum" occurs in most cases suffering from SCAD or TS with complete angiographic resolution of the dissected vessel and left ventricular dysfunction respectively. Recently, many cases, which were initially diagnosed as TS because of typical left ventricular ballooning pattern showed to have SCAD, have been reported; these cases were deemed to be "SCAD misdiagnosed as TS". The left ventricular wall motion abnormality has been attributed to the ischemia caused by SCAD-affected coronary vessel especially in the left anterior descending artery (LAD) with "wrap-around course". However, the left ventricular ballooning pattern have occurred in patients with SCAD in non-long-wrap-around LAD and SCAD in other coronary branches where coronary ischemia on its own cannot explain the left ventricular ballooning. In this review, sufficient data supporting the evidence for the possibility of coexistence of SCAD and TS is provided. Misdiagnosis of the association of the two conditions may result in mismanagement of the patient with undesirable consequences. Furthermore, the causal links between SCAD and TS is discussed.
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Affiliation(s)
- Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, Huddinge, S- 141 86, Stockholm, Sweden.
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Buccheri D, Zambelli G. The link between spontaneous coronary artery dissection and takotsubo cardiomyopathy: analysis of the published cases. J Thorac Dis 2017; 9:5489-5492. [PMID: 29312758 DOI: 10.21037/jtd.2017.11.07] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) and takotsubo cardiomyopathy (TTS) are two non-atherosclerotic causes of myocardial infarction. They share several common features. Firstly, they have a predilection for the female gender and, in both, the exact mechanism has yet to be fully established. Both they could be responsible for an acute coronary syndrome. Hence, we want to do further consideration based on pathophysiology, literature review, and cases presented affected by both entities up today.
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Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giulia Zambelli
- Cardiology Department, Paolo Giaccone Hospital, Palermo, Italy
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Madias JE. A Possible Amphidromic Relation Between Spontaneous Coronary Artery Dissection and Takotsubo Syndrome. Am J Cardiol 2017; 120:e69. [PMID: 27865484 DOI: 10.1016/j.amjcard.2016.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 11/18/2022]
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