Postpartum spontaneous dissection of the first obtuse marginal branch of the left circumflex coronary artery causing acute coronary syndrome: a case report and literature review

Shahzad, Khurram; Cao, Long; Ain, Quara Tul; Waddy, J. L.; Khan, Nawazish A.; Nekkanti, Rajasekhar

doi:10.1186/1752-1947-7-82

Cited by 16 publications

(19 citation statements)

References 25 publications

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“…Exclusion of duplicate results and articles not meeting specified a priori criteria (162 articles) resulted in 111 articles describing 138 cases of P-SCAD [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89], …”

Section: Methodsmentioning

confidence: 99%

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Paratz

Kao

MacIsaac

et al. 2018

IJC Heart & Vasculature

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BackgroundPregnancy-associated spontaneous coronary artery dissection (P-SCAD) is defined as SCAD occurring during pregnancy or within 3 months post-partum. Earlier systematic reviews have suggested a high maternal and foetal mortality rate. We undertook a structured systematic review of P-SCAD demographics, management and maternal and foetal outcomes.MethodsCase study identification was conducted according to PRISMA guidelines, with screening of all published P-SCAD cases not meeting pre-defined exclusion criteria. Of two hundred and seventy-three publications screened, one hundred and thirty-eight cases met inclusion criteria. Cases were allocated to one of three time periods; 1960–85 (twenty cases) reflecting early management of P-SCAD, 1986–2005 (forty-two cases) reflecting recent management, and 2006–16 (seventy-six cases), reflecting contemporary management.ResultsThe only significant demographic change in women experiencing P-SCAD over the last 50 years was an increasing proportion of primigravidas (p = 0.02). Management and outcomes, however, have altered significantly. Emergent angiography (p < 0.0001), reduced thrombolysis (p = 0.006) and increasingly conservative or percutaneous management (p < 0.0001) are associated with dramatic reductions in maternal mortality (85% in earliest reports to 4% in the last decade, p < 0.0001) and foetal mortality (50% in earliest reports to 0.0% in the last decade, p = 0.023).ConclusionThis systematic review of temporal changes in presentation, management and outcomes of P-SCAD represents the widest range of variables analysed in the largest cohort of P-SCAD patients to date. In the setting of earlier coronary angiography and increasingly conservative management, maternal and foetal survival rates continue to improve.

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Section: Methodsmentioning

confidence: 99%

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Paratz

Kao

MacIsaac

et al. 2018

IJC Heart & Vasculature

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“…Estudios animales muestran que tanto el estrógeno como la progesterona, ambos elevados durante el embarazo y el período periparto, pueden estimular a los eosinófilos a liberar estos gránulos con sustancias líticas. Por otra parte, durante el embarazo se producen cambios microestructurales en las fibras elásticas y coláge-nas de la túnica media de la aorta, que también se observan en las arterias coronarias, que pueden estar dadas por factores hormonales y hemodinámicos, contribuyendo a la predisposición de disección en el período periparto [1][2][3]5 . Todos estos cambios estructurales en las paredes arteriales y el estrés hemodinámico pueden persistir por un período de hasta 6 meses post parto 3,5 .…”

Section: Discussionunclassified

“…La presentación clínica suele ser variable de paciente a paciente, sin embargo, se ha descrito que el dolor torácico sería la manifestación más común 6 , el cual puede asociarse a infarto agudo al miocardio, shock cardiogénico o muerte súbita [1][2][3][4][5] . La severidad clínica va a depender entonces de la extensión de la disección y del territorio involucrado, con presentaciones que abarcan desde la ausencia de síntomas a todo el espectro de los SCA 3 .…”

Section: Discussionunclassified

“…Dentro de los factores a considerar en la elección, encontramos el estado hemodinámico del paciente, el sitio de disección, el número de vasos comprometidos, el territorio involucrado y la extensión de miocardio en riesgo [1][2][3][4][5] .…”

Section: Discussionunclassified

“…La cirugía con bypass coronario es considerada en los casos severos con enfermedad de múltiples vasos, presentaciones con inestabilidad hemodiná-mica o casos en los que hay fracaso de la revascularización 2,5 . En el caso de nuestra paciente, dada la ubicación y extensión de la disección, se optó por esta forma de terapia con un resultado exitoso.…”

Section: Discussionunclassified

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Disección coronaria espontánea post parto: reporte de un caso clínico y revisión de la literatura

S¹,

González

2014

Rev. méd. Chile

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Spontaneous coronary artery dissection in the post partum: report of one case (2) 23316934 mljofresm@gmail.com L a disección de las arterias coronarias puede ocurrir en forma espontánea o ser un evento secundario a traumatismo torácico, cirugía cardíaca, coronariografía, intervenciones coronarias o como una extensión de una disección aórtica 1 .La disección de las arterias coronarias espontánea (DACE) es un evento infrecuente, que en algunas oportunidades puede asociarse a un síndrome coronario agudo 2 . Los casos de esta patología se observan con mayor frecuencia en mujeres, presentándose hasta en 30% de las veces en el período periparto, probablemente potenciados por los cambios hormonales, estrés hemodinámico y modificaciones en el estado inmune propios de esta condición 1,3 .La disección de las arterias coronarias genera la separación de las diferentes capas de la pared arterial, con la consecuente formación de un falso lumen. El plano de disección puede ubicarse entonces entre la íntima y la media, o entre la capa media y la adventicia. De esta manera, la hemorragia en el falso lumen-y subsiguiente trombosispuede comprimir el lumen verdadero, resultando en una obstrucción oclusiva o no-oclusiva del flujo sanguíneo 1 .A continuación, presentamos un caso de disección espontánea de arterias coronarias.

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Evaluation of left ventricular function of pregnant women with autoimmune diseases using speckle tracking echocardiography

Zhang

Wang

Xiao

et al. 2023

Int J Cardiovasc Imaging

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Pregnancy can cause fluctuations in autoimmune diseases (AD) women, which may aggravate the cardiac damage. Maternal heart function is very important for maternal and fetal health. Therefore, early and accurate evaluation of the heart function of AD pregnant women is necessary. This study was aimed to evaluate the left ventricular (LV) function of AD pregnant women using two-dimensional speckle tracking echocardiography (2DSTE). A total of 96 subjects, including 26 non-pregnant AD patients (AD group), 33 AD pregnant women (AD-P group), and 37 healthy pregnant women (H-P group) were conducted. Baseline clinical and conventional echocardiography characteristics of all the subjects were collected. The 2DSTE was performed to acquire layer-specific strain parameters of LV. Compared with H-P group, AD-P group showed no significant differences in GLSmid and GLSepi. However, the GLSendo (24.10 [22.30 to 25.40] vs. 21.70 [19.05 to 25.15], P = 0.023) and ΔGLS (5.50 [4.80 to 6.00] vs. 4.90 [4.20 to 5.80], P = 0.017) were decreased, while the PSD (27 [23 to 32] vs. 32 [24 to 44], P = 0.014) was increased. At the segmental level, there was no significant difference in apex LSmid and LSepi between the two groups, while the AD-P group showed transmural dysfunction in basal and middle segments, and the LSendo in apex segments (32.84 [28.34 to 34.25] vs. 27.97 [21.87 to 33.61], P = 0.021) were significantly decreased. Compared with AD group, AD-P group showed no significant difference in ΔGLS, PSD, and GLS parameters of three layers. For the segmental level, there were no significant differences in the LSepi of the apex segment and the LS in three layers of the basal and middle segments between the two groups, while LSendo (32.69 [29.13 to 35.53] vs. 27.97 [21.87 to 33.60], P = 0.017) and LSmid (24.70 [22.24 to 27.78] vs. 21.32 [16.91 to 26.11], P = 0.023) in apex segments were significantly lower in AD-P group. The anti-SSA/Ro antibody were positive independently correlated with PSD. In conclusion, layer-specific strain parameters and PSD by 2DSTE provide an accurate and reproducible measurement of myocardial function. There are subclinical LV myocardial dysfunction in AD pregnant women. Besides, the positive of anti-SSA/Ro antibody maybe associated with LV myocardial dysfunction.

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Postpartum spontaneous dissection of the first obtuse marginal branch of the left circumflex coronary artery causing acute coronary syndrome: a case report and literature review

Cited by 16 publications

References 25 publications

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Disección coronaria espontánea post parto: reporte de un caso clínico y revisión de la literatura

Evaluation of left ventricular function of pregnant women with autoimmune diseases using speckle tracking echocardiography

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