Coronary artery dissection

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Coronary artery dissection
Classification and external resources
ICD-10 I25.4
ICD-9 414.12
DiseasesDB 3115

A coronary artery dissection (also known as spontaneous 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]

Signs and symptoms[edit]

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

Causes[edit]

SCAD[edit]

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 may sometimes be causes.[4] There is also a possibility that exercise can be a trigger. However cases sometimes have no obvious cause.[5]

Pathophysiology[edit]

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.[6][7]

Diagnosis[edit]

A selective coronary angiogram is the most common method to diagnose the condition, although it is sometimes not recognised until after death.[8] Intravascular ultrasound (IVUS) is also used as it is able to more easily differentiate the condition from atherosclerotic disease.[9]

Treatment[edit]

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.[10] Drug-eluting stents and thrombolytic drug therapy are less invasive options for less severe cases.[9]

Epidemiology[edit]

Eighty percent of cases are in women. [11]

See also[edit]

References[edit]

  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. ^ Virmani R, Forman MB, Rabinowitz M, McAllister HA (1984) "Coronary artery dissections" Cardiol Clinics
  7. ^ Kamineni R, Sadhu A, Alpert JS. (2002) "Spontaneous coronary artery dissection: Report of two cases and 50-year review of the literature" Cardiol Rev
  8. ^ C. Basso, G. L. Morgagni, G. Thiene (1996) "Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death" BMJ
  9. ^ a b Intravascular Ultrasound Imaging in the Diagnosis and Treatment: The Future: IVUS-Guided DES Implantation?
  10. ^ MedHelp:Coronary artery dissection treatment
  11. ^ Hayes, S (2013), New Insights into This Not-So-Rare Condition

External links[edit]