Spontaneous coronary artery dissection

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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 (SCAD) (occasionally coronary artery dissection) is a rare, sometimes fatal traumatic condition, with eighty percent of cases affecting women. One of the coronary arteries develops a tear, causing blood to flow between the layers which forces them apart.[1] Studies of the disease place the mortality rate at around 70%.[2][3]

SCAD (Spontaneous Coronary Artery Dissection) is a primary cause of myocardial infarction (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[edit]

The symptoms are often very similar to those of myocardial infarction (heart attack), with the most common being persistent chest pain.[4]

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, recent delivery of a baby, fibromuscular dysplasia and connective-tissue disorders (e.g., Marfan syndrome and Ehlers-Danlos syndrome) may occasionally result in SCAD.[5] There is also a possibility that vigorous exercise can be a trigger. However, many cases have no obvious cause.[6][7]

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.[8][9]

Diagnosis[edit]

A selective coronary angiogram is the most common method to diagnose the condition, although it is sometimes not recognised until after death.[10] Intravascular ultrasound (IVUS) is also used as it is able to more easily differentiate the condition from atherosclerotic disease.[11]

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.[12] Drug-eluting stents and thrombolytic drug therapy are less invasive options for less severe cases.[11]

Epidemiology[edit]

Eighty percent of cases are in women. [13]

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."
  4. ^ "Spontaneous Coronary Artery Dissection Postpartum"
  5. ^ Dhawan R, Singh G, Fesniak H. (2002) "Spontaneous coronary artery dissection: the clinical spectrum". Angiology
  6. ^ 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
  7. ^ {http://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/basics/risk-factors/con-20037794}
  8. ^ Virmani R, Forman MB, Rabinowitz M, McAllister HA (1984) "Coronary artery dissections" Cardiol Clinics
  9. ^ Kamineni R, Sadhu A, Alpert JS. (2002) "Spontaneous coronary artery dissection: Report of two cases and 50-year review of the literature" Cardiol Rev
  10. ^ C. Basso, G. L. Morgagni, G. Thiene (1996) "Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death" BMJ
  11. ^ a b Intravascular Ultrasound Imaging in the Diagnosis and Treatment: The Future: IVUS-Guided DES Implantation?
  12. ^ MedHelp:Coronary artery dissection treatment
  13. ^ Hayes, S (2013), New Insights into This Not-So-Rare Condition

External links[edit]