Coronary artery dissection

Spontaneous coronary artery dissection
Classification and external resources
Specialty cardiology
ICD-10 I25.4
ICD-9-CM 414.12
DiseasesDB 3115

A spontaneous coronary artery dissection (also known as coronary artery dissection, or SCAD) is a rare, sometimes fatal traumatic condition, with eighty percent of cases affecting women. The coronary artery develops a tear, causing blood to flow between the layers which forces them apart.[1] Early studies of the disease placed mortality rates at around 70% but more recent data indicate this figure may be closer to 18%.[2]

SCAD (Spontaneous Coronary Artery Dissection) is a primary cause of MI in young, fit, healthy women (and some men) with no obvious risk factors. These can often occur during late pregnancy, postpartum and peri-menopausal periods.

Signs and symptoms

The symptoms are often very similar to those of myocardial infarction (heart attack), with the most common being persistent chest pain.[3]

Causes

SCAD

There is evidence to suggest that a major cause of spontaneous coronary artery dissection (SCAD) is related to female hormone levels, as most cases appear to arise in pre-menopausal women, although there is evidence that the condition can have various triggers. Other underlying conditions such as hypertension, recent delivery of a baby, fibromuscular dysplasia and connective-tissue disorders (e.g., Marfan syndrome and Ehlers-Danlos syndrome) may occasionally result in SCAD.[4] There is also a possibility that vigorous exercise can be a trigger. However, many cases have no obvious cause.[5][6]

Pathophysiology

Coronary artery dissection results from a tear in the inner layer of the artery, the tunica intima. This allows blood to penetrate and cause an intramural hematoma in the central layer, the tunica media, and a restriction in the size of the lumen, resulting in reduced blood flow which in turn causes myocardial infarction and can later cause sudden cardiac death.[7][8]

Diagnosis

A selective coronary angiogram is the most common method to diagnose the condition, although it is sometimes not recognised until after death.[9] Intravascular ultrasound (IVUS) is also used as it is able to more easily differentiate the condition from atherosclerotic disease.[10]

Treatment

Treatment is varied depending upon the nature of the case. In severe cases, coronary artery bypass surgery is performed to redirect blood flow around the affected area.[11] Drug-eluting stents and thrombolytic drug therapy are less invasive options for less severe cases.[10]

Epidemiology

Eighty percent of cases are in women. [12]

See also

References

  1. Robert Slight; Ali Asgar Behranwala; Onyekwelu Nzewi; Rajesh Sivaprakasam; Edward Brackenbury; Pankaj Mankad (2003) "Spontaneous coronary artery dissection: a report of two cases occurring during menstruation" New Zealand Medical Journal]
  2. "Clinical course and long-term prognosis of spontaneous coronary artery dissection. "
  3. "Spontaneous Coronary Artery Dissection Postpartum"
  4. Dhawan R, Singh G, Fesniak H. (2002) "Spontaneous coronary artery dissection: the clinical spectrum". Angiology
  5. Mark V. Sherrid; Jennifer Mieres; Allen Mogtader; Naresh Menezes; Gregory Steinberg (1995) "Onset During Exercise of Spontaneous Coronary Artery Dissection and Sudden Death. Occurrence in a Trained Athlete: Case Report and Review of Prior Cases" Chest
  6. {http://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/basics/risk-factors/con-20037794}
  7. Virmani R, Forman MB, Rabinowitz M, McAllister HA (1984) "Coronary artery dissections" Cardiol Clinics
  8. Kamineni R, Sadhu A, Alpert JS. (2002) "Spontaneous coronary artery dissection: Report of two cases and 50-year review of the literature" Cardiol Rev
  9. C. Basso, G. L. Morgagni, G. Thiene (1996) "Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death" BMJ
  10. 1 2 Intravascular Ultrasound Imaging in the Diagnosis and Treatment: The Future: IVUS-Guided DES Implantation?
  11. MedHelp:Coronary artery dissection treatment
  12. Hayes, S (2013), New Insights into This Not-So-Rare Condition
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