Currently, the clinical recognition of scad has increased as coronary angiography is utilised frequently in the clinical evaluation of patients with acute coronary. Spontaneous coronary artery dissection scad is increasingly recognized as an important cause of myocardial infarction mi, particularly in young women. The pathophysiology and outcomes are poorly understood. This complication is rare but is more prevalent in premenopausal and middleaged women who present with myocardial infarction without atherosclerotic risks. Spontaneous coronary artery dissection scad diagnosis and. This leads to a separation and weakening of the walls of the artery scad is a major cause of heart attacks in young, otherwise healthy women without known risk factors. Spontaneous coronary artery dissection is an increasingly recognized cause of acute coronary syndrome in younger patients. Spontaneous coronary artery dissection linkedin slideshare. Coronary artery dissection an overview sciencedirect.
Spontaneous coronary artery dissection of the proximal. Spontaneous coronary artery dissection scad is an uncommon but dangerous condition in which one of the arteries that supply the heart spontaneously develops a blood collection, or hematoma, within the artery wall. Unfortunately, scad can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and sudden cardiac death. Spontaneous coronary artery dissection sometimes referred to as scad is an uncommon emergency condition that occurs when a tear forms in a blood vessel in the heart. During a coronary angiogram, doctors inject a special dye into your arteries so theyll show up on imaging tests. The majority of the victims are young, have few if any cardiac risk factors, and can dissect days to weeks before or after delivery. Outcomes of patients with spontaneous coronary artery dissection lucy mcgrathcadell,1 pamela mckenzie,2 sam emmanuel,1 david w m muller,1 robert m graham,3,4 cameron j holloway1,3,4 to cite. However, dissection may also occur spontaneously with sudden death as first manifestation 172175. There should be systematic screening of renal and carotid arteries in patients presenting with spontaneous coronary artery dissection, and patients should be followed up closely in the outpatient setting to monitor for recurrent coronary events. Methods in a retrospective study of a large cohort of patients with scad, data were collected. Spontaneous coronary artery dissection presentation was with nonstelevation myocardial infarction in 95 60. The artery wall has three layers and when a tear occurs, blood is able to pass through the innermost layer. Management includes conservative treatment, coronary stenting, or coronary artery bypass graft surgery. Coronary artery dissection an overview sciencedirect topics.
Spontaneous coronary artery dissection scad research. However, dissection may also occur spontaneously with sudden death as first manifestation 172. Republished with permission of elsevier, inc, from adlam d, olson t, combaret n et al. Any coronary artery or its branches can be involved in scad. Sep 15, 20 scad is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women. Spontaneous coronary artery dissection scad is a rare cause of acute coronary syndrome or sudden cardiac death. Incidence of catheterinduced coronary artery spasm is 0.
Background spontaneous coronary artery dissection scad is an uncommon but serious condition presenting as an acute coronary syndrome acs or cardiac arrest. Clinical features, management, and prognosis of spontaneous. The other 70% are due to a haemorrhage into the wall of a coronary artery, due probably to rupture of the small blood vessels vasa vasorum providing blood to the artery itself. Spontaneous coronary artery dissection and stsegment. Spontaneous coronary artery dissection scad may slow blood flow through the artery to the heart, which makes the heart muscle weaken. Pdf spontaneous coronary artery dissection barkatullah. Spontaneous coronary artery dissection scad is an unusual cause of acute myocardial ischemia with complex pathophysiology. Genetic disorders affecting connective tissue such as ehlers. The pathophysiology and treatment differ significantly from patients with plaque instability due to atherosclerosis. Spontaneous coronary artery dissection scad accounts for 24% of all cases of acute coronary syndrome, 2436% of myocardial infarctions mis in women coronary artery. This leads to a separation and weakening of the walls of the artery. Background spontaneous coronary artery dissection scad is underdiagnosed and an important cause of myocardial infarction mi, especially in young women.
A lack of familiarity with the condition contributes to it being missed in young women even in the presence of classic symptoms. Spontaneous coronary artery dissection extension and. Spontaneous coronary artery dissection genetic and rare. Scad is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women.
This is an emergency health situation that can cause a heart attack. Spontaneous coronary artery dissection scad is a rare but lethal cause of acute coronary syndrome that occurs in young women during the peripartumpostpartum periods. We present a case of a 41yearold woman with no significant medical history, but was a habitual ecigarette smoker who presented with atypical chest pain 2 weeks after an uncomplicated delivery while breast feeding. The case described emphasises the benefit of early diagnosis and the need to individualise management based on patient response to treatment. The rest of the artery was normal, as was the right coronary artery. The coronary artery can suddenly develop a tear, causing blood to flow between the layers which forces them apart, potentially causing a blockage of blood flow through the artery and a resulting heart attack. Unfortunately, scad can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and. Spontaneous coronary artery dissection in females with the. Mar 04, 2015 coronary artery bypass grafting cabg is best reserved for dissection involving the left main coronary artery, multivessel involvement, failed stenting, or ongoing ischemia despite medical therapy. There has been a surge in the diagnosis of scad in recent years, presumably due to an increased use of coronary angiography, and the clinical availability and application of highresolution intracoronary imaging. Management remains challenging and involves weighing the benefits of revascularization with the potential to worsen the dissection.
Background ami in the setting of scad represents an uncommon type of myocardial infarction with limited data on shortterm outcomes. Initial reports on this condition were scarce as they were based on postmortem examination of fatal cases. I am rob simari from the division of cardiovascular diseases at the mayo clinic. As a result of the haemorrhage into the wall, it bulges into the lumen of the affected vessel and blocks the flow of blood to the heart. When this happens, its called spontaneous coronary artery dissection scad. Spontaneous coronary artery dissection scad is a relatively rare, but increasingly recognized, cause of acute myocardial infarction ami, particularly among young women 11,22. Currently, the clinical recognition of scad has increased as coronary angiography is utilised frequently in the clinical evaluation of patients with acute coronary syndromes. Evaluation and management of chest pain after spontaneous coronary artery dissection scad. Nov 27, 2014 spontaneous coronary artery dissection scad is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome acs. Traditionally, all patients with ataad are typically treated with.
Coronary dissection and its progression into arcus. Spontaneous coronary artery dissection is a rare cause of myocardial ischaemia or sudden death, predominantly affecting young women with no known risk factors for cardiovascular disease. Coronary artery bypass grafting cabg is best reserved for dissection involving the left main coronary artery, multivessel involvement, failed stenting, or ongoing ischemia despite medical therapy. It is defined as a spontaneous tear in the coronary arterial wall that is not traumatic or iatrogenic. Spontaneous coronary artery dissection aha journals. Depending on the degree of blockage, symptoms can range from chest pain to heart attack or cardiac. Spontaneous coronary artery dissection scad is gaining recognition as an important cause of myocardial infarction, especially in young women. This leads to external compression of the true coronary lumen restricting. It is defined as a nontraumatic and noniatrogenic separation of the coronary artery wall, which creates a false lumen that may or may not be in continuity with the true lumen. Spontaneous coronary artery dissection is an important cause of acute myocardial infarction, especially in young women.
Spontaneous coronary artery dissection scad is defined as coronary dissection without atherosclerotic and traumatic causes. Recurrent spontaneous coronary artery dissection in the. Spontaneous coronary artery dissection scad has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Spontaneous coronary artery dissection scad is an important cause of myocardial infarction, especially in young women, but its prevalence is uncertain because its underdiagnosed.
Spontaneous coronary artery dissection scad can be defined as the acute development of a false lumen within the coronary artery wall that may lead to flow limitation by compression of the true coronary lumen. Longterm cardiovascular outcomes, including recurrent scad, are inadequately reported. Spontaneous coronary artery dissection scad symptoms. Spontaneous coronary artery dissection scad is an uncommon cause of acute coronary syndrome in younger females with no preexisting history of coronary artery disease. Spontaneous coronary artery dissection scad is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome acs. Aortic and coronary artery dissection during percutaneous. Coronary artery dissection is a rare but potentially catastrophic complication of coronary angiography. Outcomes of patients with spontaneous coronary artery dissection.
Whether medical therapy is instituted or stenting or cabg is performed, mdct can be useful in following patients with scad. Spontaneous coronary artery dissection request pdf. Spontaneous coronary artery dissection scad is a rare clinical entity of unknown cause that typically affects young women without coronary. Left ventriculography showed a left ventricular aneurysm, a left ventricular ejection fraction of 0. Background spontaneous coronary artery dissection scad is underdiagnosed and an important cause of myocardial infarction mi. Despite its rarity, it can still affect 515% of the patients, and it is caused by malperfusion from the dissection flap occluding or inducing thrombosis in the distal aortic branch arteries of the lower limbs3,4. Spontaneous coronary artery dissection scad is an uncommon and poorly understood. Recurrent spontaneous coronary artery dissection in the united states chayakrit krittanawonga, anirudh kumarb, hafeez ul hassan virk c, zhen wangd,e, kipp w. Spontaneous coronary artery dissection of the proximal left. Spontaneous peripartum coronary artery dissection spcad is a rare but devastating complication of term pregnancy in women. Spontaneous coronary artery dissection scad is an increasingly recognised cause of nonatherosclerotic acute coronary syndromes leading to myocardial infarction. We investigated the characteristics and outcomes of patients presenting with scad. Spontaneous coronary artery dissection scad is a condition in which blood accumulates between the layers of tissue that make up the wall of the coronary artery the vessel that supplies blood to the heart.
Although it is a nonatherosclerotic condition, its origin is unknown. This retrospective singlecenter study evaluated clinical features, associations, management strategies, and early and late outcomes in 87 patients with. We present a case of spontaneous coronary artery dissection with the superimposed complexity of an anomalous. Diagnosis can be challenging, with a high degree of clinical suspicion necessary. Oct 31, 2019 spontaneous coronary artery dissection sometimes referred to as scad is an uncommon emergency condition that occurs when a tear forms in a blood vessel in the heart. Spontaneous coronary artery dissection scad is a nontraumatic and noniatrogenic separation of the coronary arterial wall and is a rare cause of acute myocardial infarction. Management of lower limb ischemia during operative repair. In spontaneous coronary artery dissection scad, the arteries in the heart coronary arteries may sometimes be twisted tortuous arteries. Scad is a major cause of heart attacks in young, otherwise. Apr 01, 2019 spontaneous coronary artery dissection scad, an intramural hemorrhage leading to a separation of the layers of the coronary artery wall, is traditionally considered a rare condition associated mainly with pregnancy but is likely underdiagnosed in other settings. Spontaneous coronary artery dissection scad mayo clinic. Spontaneous coronary artery dissection is an infrequent but increasingly recognized cause of acute coronary syndrome. Pdf spontaneous coronary artery dissection nicolas.
Induced spiral dissection of the left main coronary. Spontaneous coronary artery dissection scad symptoms and. It is characterised by the presence of blood entering and separating the layers of the coronary arterial wall to form a false lumen. This definition of scad excludes coronary dissections that are secondary to atherosclerotic disease, produced by the extension of an aortic dissection, iatrogenic or. Spontaneous coronary artery dissection is uncommon and often misdiagnosed. Coronary computed tomography angiography of spontaneous. Not just a heart attack sometimes a heart attack is not just a heart attack, but the result of spontaneous tearing in the coronary artery wall.
Other aspects of coronary heart disease in women are discussed. Spontaneous coronary artery dissection circulation. Spontaneous coronary artery dissection bmj case reports. Coronary artery dissection is a wellknown complication of invasive procedures e. Spontaneous coronary artery dissection scad is increasingly recognised as an important cause of myocardial infarction mi, especially in younger women. It is more common in younger patients and in women. Outcomes of patients with spontaneous coronary artery. Patients with spcad reported in the recent literature were analyzed to elucidate the clinically relevant characteristics of this condition. Spontaneous coronary artery dissection scad has emerged as an important cause of acute coronary syndrome, myocardial infarction, and. The trapped blood then creates a blockage which interferes with blood flow to the heart. Scad most commonly affects women in their 40s and 50s. The lad and the lcx both arise from the left main coronary artery. May, 2019 spontaneous coronary artery dissection scad can be defined as the acute development of a false lumen within the coronary artery wall that may lead to flow limitation by compression of the true coronary lumen.
Spontaneous coronary artery dissection is characterised by a plane that usually runs in the outer media or between the media and adventitia of the coronary artery, resulting in haemodynamic compromise due to the flap, with blood tracking in it, compressing the lumen. Feb 25, 2016 spontaneous coronary artery dissection scad is a condition in which blood accumulates between the layers of tissue that make up the wall of the coronary artery the vessel that supplies blood to the heart. Spontaneous coronary artery dissection is a rarely identified entity whose exact incidence, etiology, pathogenesis, mediumterm evolution, and optimal treatment have not yet been firmly established. Objectives this study sought to describe the acute and longterm cardiovascular outcomes and assess the predictors of recurrent scad. Recurrent scad is common after a first episode and can involve the same coronary artery or present as a new dissection unrelated to the initial lesion. Refer patients with spontaneous coronary artery dissection scad to these online resources. Spontaneous coronary artery dissection scad is an important cause of myocardial. Spontaneous coronary artery dissection scad is a nontraumatic and. Methods in a retrospective study of a large cohort of patients with scad, data. Medical management is usually indicated, except in certain circumstances in which. Scad can slow or block blood flow to the heart, causing a heart attack, abnormalities in heart rhythm or sudden death.
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