Spontaneous Coronary Artery Dissection A Case Report and Review of the Literature

Mohamed, Hassan A; Eshawesh, Abdulhamid; Habib, Naiyer

doi:10.1177/000331970205300212

Cited by 37 publications

(50 citation statements)

References 40 publications

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“…Although several mechanisms have been postulated, no single aetiology completely explains the pathogenesis of spontaneous coronary dissection: prompt diagnosis and timely appropriate treatment are usually associated with successful outcome [33].…”

Section: Discussionmentioning

confidence: 99%

Normal angiogram in acute coronary syndromes: The underestimated role of alternative substrates of myocardial ischemia

Rigatelli¹,

Rigatelli²,

Paolo³

et al. 2004

Int J Cardiovasc Imaging

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The study is aimed at evaluating the real incidence of normal coronary arteries and the role of alternative substrates of myocardial ischemia in patients with acute coronary syndrome (ACS) but with no coronary artery disease (CAD) in a real world secondary care public hospital. The medical records of 941 patients undergoing coronary arteriography for ACS within 48 h of onset between January 1st 2000 and November 1st 2003 were critically reviewed. In 70 patients (7.4%, 35 males, mean age 60 +/- 17.2 years) no CAD was documented. Alternative substrates of acute myocardial ischemia included coronary artery anomalies (7 patients, 10%), coronary spasm (10 patients, 14.3%), spontaneous coronary dissection (2 patients, 2.8%), paradoxical embolism through a patent foramen ovale (4 patients, 5.7%), embolism from left atrium or calcified aortic valve (4 patients, 5.7%), imbalance between oxygen demand and supply (20 patients, 28.5%), mitral valve prolapse (11 patients, 15.7%). No alternative substrates were found in 12 patients (17.1%). Patients with no CAD are more frequently female and younger. Absence of CAD is an uncommon finding in patients undergoing coronary artery angiography for ACS.

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Section: Discussionmentioning

confidence: 99%

Normal angiogram in acute coronary syndromes: The underestimated role of alternative substrates of myocardial ischemia

Rigatelli¹,

Rigatelli²,

Paolo³

et al. 2004

Int J Cardiovasc Imaging

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show abstract

“…A majority of patients presenting with this entity do not have classical risk factors for coronary heart disease and most reported cases were diagnosed postmortem [1,2]. Th e etiology is not known; however, in literature three diff erent groups of patients with SCAD are distinguished [1]: (a) patients with underlying Persistent spontaneous dissection of the LAD coronary artery wkw 15-16/2010 © Springer-Verlag coronary atherosclerosis, (b) women in the peripartal period, in whom elevated hemodynamic stress and arterial wall changes under hormonal infl uence is hypothesized as contributing to the development of SCAD [3], and (c) an "idiopathic" group including patients with diff erent connective pathologies like polyarteritis nodosa, lupus erythematosus, tissue disorders, or in association with the use of cocaine, cyclosporin, and oral contraceptives as well as in athletes during performance of heavy exercise [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Persistent spontaneous dissection of the left anterior descending coronary artery after emotional pressure

Mayr

Klug

Jaschke

et al. 2010

Wien Klin Wochenschr

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A 51-year-old woman without cardiovascular risk factors experienced severe chest pain, accompanied by ST-segment elevation in lead II, III, AVF, and V4-V6. An immediately started thrombolytic therapy in a peripheral hospital successfully eliminated the cardiac symptoms and achieved complete ST-segment resolution. Subsequent cardiac angiography revealed a longitudinal spontaneous dissection in the distal part of the left anterior descending artery. Due to the small vessel size we decided on conservative therapeutic procedure with acetyl salicylamide, clopidogrel, statin, and beta blocker. Three months later, control angiography presented no resolution of the dissection and the patient showed excellent performance on stress test with no signs of ischemia.

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“…A repeat echocardiogram at that time demonstrated that the EF estimated at 60-65%, had returned to normal. Discussion SCAD, with a reported mortality of up to 80%, is an uncommon cause of acute coronary syndrome [1][2][3][4][5]. It commonly occurs in younger patients, typically pregnant women during their pre-partum or postpartum periods.…”

Section: Case Reportmentioning

confidence: 99%

“…It often affects younger, otherwise healthy patients [1][2][3][4][5], but can also be associated with atherosclerotic plaque rupture, chest trauma, or connective tissue diseases such as Marfan's syndrome and EhlersDanlos type IV. We herein report a case of SCAD associated with acute pulmonary embolism occurring in a postpartum patient who was successfully treated with thrombectomy and stent placement.…”

Section: Introductionmentioning

confidence: 99%

A Case of Post-partum Spontaneous Coronary Artery Dissection with Pulmonary Embolism: Survival with Thrombectomy and Stent Implant.

Thei¹

2015

J Clin Case Rep

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Spontaneous Coronary Artery Dissection (SCAD) is a rare life-threatening cause of acute coronary syndrome. It can affect young patients without atherosclerotic risk factors, particularly women in the antepartum or early post-partum period, as well as geriatric patients at high risk for atherosclerotic disease. The pathogenesis linking SCAD with pregnancy has not been fully elucidated. The few reported cases of SCAD in the setting of concomitant Pulmonary Embolism (PE) may highlight a potential mechanism in the pregnant or postpartum woman. Heretofore, cases of SCAD with the setting of pulmonary embolism have all been treated conservatively with medical therapy. We herein report a case of SCAD in the left anterior descending artery resulting in Non-ST elevation myocardial infarction and low ejection fraction associated with an acute pulmonary embolism in a young post-partum patient who was treated successfully with thrombectomy followed by stent placement. Her cardiac function returned to normal within six months with no recurrence of symptoms. To our knowledge, this is the first case of SCAD in the setting of pulmonary embolism who was successfully treated with thrombectomy and stent placement.

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Spontaneous Coronary Artery Dissection A Case Report and Review of the Literature

Cited by 37 publications

References 40 publications

Normal angiogram in acute coronary syndromes: The underestimated role of alternative substrates of myocardial ischemia

Normal angiogram in acute coronary syndromes: The underestimated role of alternative substrates of myocardial ischemia

Persistent spontaneous dissection of the left anterior descending coronary artery after emotional pressure

A Case of Post-partum Spontaneous Coronary Artery Dissection with Pulmonary Embolism: Survival with Thrombectomy and Stent Implant.

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