Spontaneous Coronary Artery Dissection Associated with Anal Cancer Management with Fluorouracil and Radiotherapy

Hart, Kimberly; Patel, Suketu; Kovoor, Joshua

doi:10.7759/cureus.4979

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…In general, research is lacking about the impact of medications, including chemotherapeutics, or exogenous factors such as radiotherapy on SCAD risk. 299,300 Radiotherapy increases the risk of arterial and coronary dissection 299,300 and increases circulating, 301 vascular, 302 and myocardial 303,304 levels of ET-1 and thereby could also promote SCAD.…”

Section: Spontaneous Coronary Artery Dissection (Scad)mentioning

confidence: 99%

Endothelin: 30 Years From Discovery to Therapy

2019

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Discovered in 1987 as a potent endothelial cell–derived vasoconstrictor peptide, endothelin-1 (ET-1), the predominant member of the endothelin peptide family, is now recognized as a multifunctional peptide with cytokine-like activity contributing to almost all aspects of physiology and cell function. More than 30 000 scientific articles on endothelin were published over the past 3 decades, leading to the development and subsequent regulatory approval of a new class of therapeutics—the endothelin receptor antagonists (ERAs). This article reviews the history of the discovery of endothelin and its role in genetics, physiology, and disease. Here, we summarize the main clinical trials using ERAs and discuss the role of endothelin in cardiovascular diseases such as arterial hypertension, preecclampsia, coronary atherosclerosis, myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) caused by spontaneous coronary artery dissection (SCAD), Takotsubo syndrome, and heart failure. We also discuss how endothelins contributes to diabetic kidney disease and focal segmental glomerulosclerosis, pulmonary arterial hypertension, as well as cancer, immune disorders, and allograft rejection (which all involve ET A autoantibodies), and neurological diseases. The application of ERAs, dual endothelin receptor/angiotensin receptor antagonists (DARAs), selective ET B agonists, novel biologics such as receptor-targeting antibodies, or immunization against ET A receptors holds the potential to slow the progression or even reverse chronic noncommunicable diseases. Future clinical studies will show whether targeting endothelin receptors can prevent or reduce disability from disease and improve clinical outcome, quality of life, and survival in patients.

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Section: Spontaneous Coronary Artery Dissection (Scad)mentioning

confidence: 99%

Endothelin: 30 Years From Discovery to Therapy

2019

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“…Extreme physical or emotional stress is probably the most important predisposing factor. Triggering factors leading to a Valsalva-like increase in thoracoabdominal pressure or raising catecholamines, including cocaine exposure or sympathomimetic drugs, intense physical activity, coughing, retching, vomiting and bowel movement, in combination with underlying predisposing arteriopathies, can increase cardiocirculatory shear stress resulting in SCAD[ 11 , 15 , 31 , 32 ]. Specifically, emotional stressors seem to appear more often in women, whereas physical stressors have been reported in men among precipitants[ 16 , 29 ].…”

Section: Risk Factorsmentioning

confidence: 99%

Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

Lionakis¹,

Briasoulis²,

Zouganeli³

et al. 2022

World J Cardiol

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Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic, non-traumatic separation of the coronary artery wall. The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors. SCAD is frequently linked with predisposing factors, such as postpartum, fibromuscular dysplasia or other vasculopathies, connective tissue disease and hormonal therapy, and it is often triggered by intense physical or emotional stress, sympathomimetic drugs, childbirth and activities increasing shear stress of the coronary artery walls. Patients with SCAD usually present at the emergency department with chest discomfort, chest pain, and rapid heartbeat or fluttery. During the last decades, the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis. However, modern imaging techniques such as optical coherence tomography, intravascular ultrasound, coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease. Treatment of SCAD remains controversial, especially during the last years, where invasive techniques are being used more often and in more emergent cardiac syndromes. Although conservative treatment combining aspirin and beta-blocker remains the recommended strategy in most cases, revascularization could also be suggested as a method of treatment in specific indications, but with a higher risk of complications. The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients. Follow-up should be performed on a regular basis.

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“…There are few case reports of SCAD occurring in cancer patients undergoing chemotherapy with 5-FU and/or cisplatin [ 142 , 143 , 144 ], bone marrow transplant for chronic lymphocytic leukemia [ 145 ], and in patients without active cancer treatment [ 146 ]. None of these patients had significant atherosclerotic disease on coronary angiography.…”

Section: Etiology and Mechanisms Of Myocardial Infarction In Cancer P...mentioning

confidence: 99%

Mechanisms of Myocardial Ischemia in Cancer Patients: A State-of-the-Art Review of Obstructive Versus Non-Obstructive Causes

Balanescu¹,

Bloomingdale²,

Donisan³

et al. 2022

Rev. Cardiovasc. Med.

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In patients with cancer, myocardial infarction (MI) has distinct features and mechanisms compared to the non-oncology population. Triggers of myocardial ischemia specific to the oncology population have been increasingly identified. Coronary plaque disruption, coronary vasospasm, coronary microvascular dysfunction, spontaneous coronary artery dissection, and coronary oxygen supply-demand mismatch are all causes of MI that have been shown to have specific triggers related to either the treatments or complications of cancer. MI can occur in the presence or absence of atherosclerotic coronary artery disease (CAD). MI with nonobstructive CAD (MINOCA) is a heterogeneous syndrome that has distinct pathophysiology and different epidemiology from MI with significant CAD (MI-CAD). Recognition and differentiation of MI-CAD and MINOCA is essential in the oncology population, due to unique etiology and impact on diagnosis, management, and overall outcomes. There are currently no reports in the literature concerning MINOCA as a unified syndrome in oncology patients. The purpose of this review is to analyze the literature for studies related to known triggers of myocardial ischemia in cancer patients, with a focus on MINOCA. We propose that certain cancer treatments can induce MINOCA-like states, and further research is warranted to investigate mechanisms that may be unique to certain cancer states and types of treatment.

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Spontaneous Coronary Artery Dissection Associated with Anal Cancer Management with Fluorouracil and Radiotherapy

Cited by 3 publications

References 11 publications

Endothelin: 30 Years From Discovery to Therapy

Endothelin: 30 Years From Discovery to Therapy

Spontaneous coronary artery dissection: A review of diagnostic methods and management strategies

Mechanisms of Myocardial Ischemia in Cancer Patients: A State-of-the-Art Review of Obstructive Versus Non-Obstructive Causes

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