Follow up after spontaneous coronary artery dissection: a report of five cases.

Zampieri, P.; Aggio, Silvio; Roncon, Loris; Rinuncini, Massimo; Canova, Corina; Zanazzi, George; Fiorencis, R; Zonzin, P.

doi:10.1136/hrt.75.2.206

Cited by 103 publications

(89 citation statements)

References 16 publications

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“…8,9 Men frequently present at a slightly later age, usually with involvement of the right coronary artery (RCA), with evidence of CAD or risk factors for atherosclerosis. 1,8,12,13 Unlike intimal dissection that occurs with significant preexisting atherosclerosis, the plane of dissection in SCAD usually lies within the outer third of the tunica media or between the media and adventitia. 11,[14][15][16][17][18] The dissection is typically observed in one vessel, but may encompass several coronary arteries concomitantly, including the LMCA.…”

Section: Incidence and Clinical Presentationmentioning

confidence: 99%

“…[2][3][4][5][6] Patients with SCAD have traditionally been assigned to three groups: those who present with (a) significant preexisting atherosclerosis, (b) during the peripartum period or in association with oral contraceptive use, and (c) idiopathic presentation. 1,[7][8][9][10] Women with SCAD frequently present during the peripartum period or in association with oral contraceptive use with involvement of the left anterior descending (LAD) artery and/or LMCA, usually in the absence of traditional risk factors for coronary artery disease (CAD). In their review of peripartum cases, Koul et al 11 reported that 22% presented during pregnancy and 78% presented in the postpartum period.…”

Section: Incidence and Clinical Presentationmentioning

confidence: 99%

“…1 Patients may present with chronic stable angina, acute coronary syndromes, myocardial infarction, cardiogenic shock, sudden cardiac death, or pericardial tamponade. Sudden death may occur in up to 50% of cases, particularly in those with left main coronary artery (LMCA) dissection.…”

Section: Incidence and Clinical Presentationmentioning

confidence: 99%

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Spontaneous coronary artery dissection

Almeda

Barkatullah

Kavinsky

2004

Clinical Cardiology

101

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Summary: Spontaneous coronary artery dissection (SCAD)is an unusual cause of acute myocardial ischemia with complex pathophysiology. This paper reviews the major diagnostic and therapeutic issues of this rare but important disease. The diagnosis of SCAD should be strongly considered in any patient who presents with symptoms suggestive of acute myocardial ischemia, particularly in young subjects without traditional risk factors for coronary artery disease (especially in young women during the peripartum period or in association with oral contraceptive use). Urgent coronary angiography is indicated to establish the diagnosis and to determine the appropriate therapeutic approach. The decision to pursue medical management, percutaneous coronary intervention, or surgical revascularization is based primarily on the clinical presentation, extent of dissection, and amount of ischemic myocardium at risk.

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Section: Incidence and Clinical Presentationmentioning

confidence: 99%

Section: Incidence and Clinical Presentationmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous coronary artery dissection

Almeda

Barkatullah

Kavinsky

2004

Clinical Cardiology

101

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“…Similar factors have been implicated in increased cardiovascular event rates observed in young patients undergoing chemotherapy for testicular cancer (3). Despite this, no cases of SCAD occurring during cisplatin-based chemotherapy for testicular cancer have been reported.The presentation, outcome and management of acute spontaneous coronary artery dissection have been described extensively (4)(5)(6)(7)(8). In all of these reports, there was either no angiographic follow-up of patients who survived the acute event or follow-up angiography demonstrated complete healing of the dissection.…”

mentioning

confidence: 99%

“…The presentation, outcome and management of acute spontaneous coronary artery dissection have been described extensively (4)(5)(6)(7)(8). In all of these reports, there was either no angiographic follow-up of patients who survived the acute event or follow-up angiography demonstrated complete healing of the dissection.…”

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An unusual case of chronic coronary artery dissection: Did cisplatin play a role?

Ghosh

Chow

Korley

et al. 2008

Canadian Journal of Cardiology

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S pontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial ischemia (1). It is more common in younger patients and in women, and has a propensity to affect patients without traditional cardiovascular risk factors (2). The tendency to affect women in high estrogenic states suggests that the hormonal and thrombogenic status of the patient may play etiological roles in SCAD. Similar factors have been implicated in increased cardiovascular event rates observed in young patients undergoing chemotherapy for testicular cancer (3). Despite this, no cases of SCAD occurring during cisplatin-based chemotherapy for testicular cancer have been reported.The presentation, outcome and management of acute spontaneous coronary artery dissection have been described extensively (4)(5)(6)(7)(8). In all of these reports, there was either no angiographic follow-up of patients who survived the acute event or follow-up angiography demonstrated complete healing of the dissection. The long-term outcome of the dissection that persists is less well described (9,10).We report a case of chronic coronary artery dissection that had its onset during a course of bleomycin-etoposide-cisplatin therapy for testicular cancer. The implications of testicular cancer and chemotherapy, and the significance of chronic coronary artery dissection persistent on angiography will be discussed. CASE PRESENTATIONA 36-year-old man presented with a history of lightheadedness, shortness of breath and left-sided chest tightness after several minutes of playing hockey. Emergency medical services arrived at the scene and found the patient in monomorphic ventricular tachycardia at approximately 300 beats/min (Figure 1). The patient underwent electrical cardioversion, with almost immediate resolution of his symptoms. On admission to a local hospital, his troponin I peaked at 0.6 μg/L (10 times the upper limit of normal), and his electrocardiogram (ECG) showed significant Q waves in leads II, III and AVF, as well as ST depression in the inferolateral leads. The Q waves in the inferior leads were unchanged from previous ECGs recorded since July 1994. At the time of the current presentation, the patient was taking ramipril and Lipitor (Pfizer, Canada). He did not smoke and rarely used alcohol. He was started on acetylsalicylic acid, clopidogrel, enoxaparin and metoprolol by the referring centre, and was transferred to a tertiary care centre for further investigation.His medical history was relevant. At the age of 24 years he developed testicular cancer, which was treated with four cycles of chemotherapy following orchiectomy. During his last course of bleomycin-etoposide-cisplatin chemotherapy, the patient developed left chest, neck and shoulder discomfort, and presented to the hospital 12 h later. Serial ECGs revealed the development of a Q wave inferior infarction and poor R wave progression across precordial leads on serial tracings. He did not receive thrombolysis, and cardiac catheterization was not performed. He was sent home on acetylsalic...

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