Spontaneous coronary dissection misdiagnosed as, or triggering, or triggered by, Takotsubo syndrome?

Spontaneous coronary artery dissection and its association with takotsubo syndrome: Novel insights from a tertiary center registry

“…We waited to publish this hypothesis until our registry had grown sufficiently in size and the coronary angiograms with simultaneous left ventriculograms had been carefully analyzed by an independent and blinded angiographic core laboratory. This hypothesis was later confirmed . Finally, the presence of coronary artery tortuosity may also lead to increased shear stress and ultimately lead to vascular vulnerability.…”

Spontaneous coronary artery dissection and takotsubo syndrome: Simultaneous presentation or which triggers which?

“…Dr. Madias hypothesizes that this transition zone could create a hinging point exerting mechanical strain on the coronary arteries, which could precipitate SCAD in predisposed subjects. That the dissected obtuse‐marginal branch in our case report was at a distance from the hinging point does not exclude this hypothesis according to Dr. Madias explanation because the hinging point between the well and poorly contracting regions may have been closer to obtuse‐marginal artery, since it has been reported that the regional contraction abnormalities occasionally migrates to the various parts of the left ventricle in the course of the same TS attack . Further explanation according to Dr. Madias is that “one could conceive maximal mechanical force being applied in one part of the coronary artery, with SCAD occurring in different part, more vulnerable, of the same artery.” This hypothesis is plausible and appealing but needs to be confirmed.…”

“…I greatly appreciate Dr. Madias interest in reading and commenting our case report where a 54‐year‐old‐woman presented with concurrent spontaneous coronary artery dissection (SCAD) of the obtuse‐marginal artery and mid‐apical pattern of takotsubo syndrome (TS) . In TS, there may be a sharp transition zone between the affected akinetic stunned myocardial wall and the hyperkinetic segments.…”

Could echocardiography determine whether spontaneous coronary dissection is occasionally associated with Takotsubo syndrome?

“…There are cases reported in the literature showing that TTS occasionally follows SCAD . Also, the reverse has been hypothesized, that is, that SCAD may occasionally be triggered by TTS, instead of triggering it . In this scenario, the myocardial areas of vigorously contracting cardiac base, abutting akinetic/dyskinetic midventricular regions, generate hinge points, which could lead to SCAD in patients with predilection for this pathology, including the ones with fibromuscular dysplasia .…”

“…Also, the reverse has been hypothesized, that is, that SCAD may occasionally be triggered by TTS, instead of triggering it . In this scenario, the myocardial areas of vigorously contracting cardiac base, abutting akinetic/dyskinetic midventricular regions, generate hinge points, which could lead to SCAD in patients with predilection for this pathology, including the ones with fibromuscular dysplasia . Also, the scenario of TTS being triggered by SCAD could be explained along the lines of physical stress due to the latter causing the former, as in other published cases of patients with acute coronary syndromes (ACS), and frank ST‐elevation myocardial infarction (the stress), resulting in associated TTS …”