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Rathi AC, Nagtode N, Chandra V, Pathade AG, Yelne S. Critical Insights Into the Management of Postpartum Left Main Spontaneous Coronary Artery Dissection: Current Strategies and Future Directions. Cureus 2023; 15:e44622. [PMID: 37799221 PMCID: PMC10548014 DOI: 10.7759/cureus.44622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/03/2023] [Indexed: 10/07/2023] Open
Abstract
This review article delves into the multifaceted realm of postpartum left main spontaneous coronary artery dissection (PLMSCAD), an infrequent yet critical condition affecting women during the postpartum period. Through a comprehensive exploration of its pathophysiology, clinical presentation, diagnosis, management strategies, and future directions, this review provides a holistic understanding of PLMSCAD's complexities. The article highlights challenges in diagnosis due to overlapping symptoms and underscores the significance of prompt recognition and tailored interventions. Current management strategies, encompassing medical and interventional approaches, are analysed in the context of their short-term and long-term impact on patient outcomes. Ethical considerations and the role of patient education and support networks are explored, shedding light on the broader psychosocial dimensions of PLMSCAD management. As emerging research reveals insights into genetic influences, hormonal dynamics, and the prognosis of affected individuals, this review emphasises the necessity of collaborative research endeavours and data sharing to enhance our understanding and guide future strategies. Ultimately, this review underscores the urgency of addressing the unique needs of women experiencing PLMSCAD, urging ongoing research, multidisciplinary collaboration, and a patient-centred approach to optimise maternal health outcomes and well-being.
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Affiliation(s)
- Arya C Rathi
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikhilesh Nagtode
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vaibhav Chandra
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aniket G Pathade
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Madkour M, Mukherjee A. Rare Sequela of Spontaneous Coronary Artery Dissection. Cureus 2023; 15:e37645. [PMID: 37206492 PMCID: PMC10190114 DOI: 10.7759/cureus.37645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/21/2023] Open
Abstract
Non-atherosclerotic spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Here, we report a case of acute ischemic mitral regurgitation (MR) due to SCAD of the left main coronary artery. Given the extent of the acute ischemic MR and multi-vessel disease, the decision was made to pursue coronary artery bypass graft surgery and annuloplasty mitral valve ring repair.
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Affiliation(s)
- Muhammad Madkour
- Cardiovascular Disease, Riverside Community Hospital, Riverside, USA
| | - Ashis Mukherjee
- Cardiovascular Disease, University of California Riverside School of Medicine, Riverside, USA
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3
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Kumar T, Prajapati A, Shah MM. Spontaneous coronary artery dissection involving all major arteries LAD, LCX and RCA -A case report. J Family Med Prim Care 2019; 8:3739-3741. [PMID: 31803682 PMCID: PMC6881937 DOI: 10.4103/jfmpc.jfmpc_834_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 09/27/2019] [Accepted: 10/14/2019] [Indexed: 11/29/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden cardiac death. Amongst various etiologies thought to be responsible for this condition, atherosclerosis seems to be the most common. There are various case reports on (SCAD) of single coronary artery but the presence of SCAD of all three arteries is not known. We describe a case of a 45-year-old gentleman without any conventional coronary risk factors, who was referred to us at Tata Main hospital, Jamshedpur, for cardiac evaluation prior to his urethral surgery. Although asymptomatic cardiac-wise, his ECG incidentally revealed healed inferior wall myocardial infarction. Echocardiogram confirmed hypokinetic inferior wall with left ventricular ejection fraction of 50%. His coronary angiography showed spontaneous dissection of LAD, LCX and RCA which was managed conservatively.
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Affiliation(s)
- Tapan Kumar
- Department of Cardiology, TMH Jamshedpur, Bunglow No -6, D Road East, Northern Town, Bistupur, Jamshedpur, Jharkhand, India
| | - Aparna Prajapati
- Department of Cardiology, TMH Jamshedpur, Bunglow No -6, D Road East, Northern Town, Bistupur, Jamshedpur, Jharkhand, India
| | - Mandar M. Shah
- Department of Cardiology, TMH Jamshedpur, Bunglow No -6, D Road East, Northern Town, Bistupur, Jamshedpur, Jharkhand, India
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4
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Benahmed I, El Kasimi A, Laachach H, Ismaili N, elouafi N. Spontaneous Coronary Artery Dissection (SCAD): A Series of 7 Cases, Experience of the University Hospital Center Mohammed VI, Oujda, Morocco. Adv Med 2018; 2018:1964394. [PMID: 30386796 PMCID: PMC6189686 DOI: 10.1155/2018/1964394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/07/2018] [Indexed: 11/26/2022] Open
Abstract
Spontaneous coronary artery dissection is a less known pathology by the cardiologists and represents a real challenge especially to the interventional cardiologist. The positive diagnosis is based on the visualization of intimal flap with the false lumen by intracoronary imaging means. This entity particularly interests young people without classic cardiovascular risk factors of atherosclerosis and female during the peripartum period. We report, in this paper, our experience in the University Hospital Center of Mohammed VI, Oujda, Morocco, about 7 cases diagnosed by coronary angiography during 3 years of practice while comparing our results with data from large series published in the literature. The purpose of this work is to draw more attention to this particular pathology that is becoming more and more common.
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Affiliation(s)
- I. Benahmed
- Cardiology Department, University Hospital Center Mohammed VI, Oujda, Morocco
| | - A. El Kasimi
- Cardiology Department, University Hospital Center Mohammed VI, Oujda, Morocco
| | - H. Laachach
- Cardiology Department, University Hospital Center Mohammed VI, Oujda, Morocco
| | - N. Ismaili
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine, University of Mohammed First, Oujda, Morocco
| | - N. elouafi
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine, University of Mohammed First, Oujda, Morocco
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5
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Paratz ED, Kao C, MacIsaac AI, Somaratne J, Whitbourn R. Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2018; 18:1-6. [PMID: 29750179 PMCID: PMC5941240 DOI: 10.1016/j.ijcha.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 12/13/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pregnancy-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. METHODS Case 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. RESULTS The 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). CONCLUSION This 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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Affiliation(s)
| | - Chien Kao
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
| | | | - Robert Whitbourn
- Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
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6
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Havakuk O, Goland S, Mehra A, Elkayam U. Pregnancy and the Risk of Spontaneous Coronary Artery Dissection: An Analysis of 120 Contemporary Cases. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.004941. [PMID: 28302642 DOI: 10.1161/circinterventions.117.004941] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because of the rarity of this condition, information on pregnancy-associated spontaneous coronary artery dissection is limited. We reviewed a large number of contemporary pregnancy-associated spontaneous coronary artery dissection cases in an attempt to define the clinical characteristics and provide management recommendations. METHODS AND RESULTS A literature search for cases of pregnancy-associated spontaneous coronary artery dissection reported between 2000 and 2015 included 120 cases; 75% presented with ST-segment-elevation myocardial infarction, and 80% had anterior myocardial infarction. Left anterior descending coronary artery was involved in 72% of cases, left main segment in 36%, and 40% had multivessel spontaneous coronary artery dissection. Ejection fraction was reduced to <40% in 44% of cases. Percutaneous coronary intervention was successful in only 50% of cases. Coronary artery bypass surgery was performed in 44 cases because of complex anatomy, hemodynamic instability, or failed percutaneous coronary intervention. Maternal complications included cardiogenic shock (24%), mechanical support (28%), urgent percutaneous coronary intervention (28%), urgent coronary artery bypass surgery (27.5%), maternal mortality (4%), and fetal mortality (2.5%). During follow-up for 305±111 days, there was a high incidence of symptoms because of persistent or new spontaneous coronary artery dissections, and 5 women needed heart transplantation or ventricular assist device implantation. CONCLUSIONS Pregnancy-associated spontaneous coronary artery dissection is commonly associated with left anterior descending, left main, and multivessel involvement, which leads to a high incidence of reduced ejection fraction, and life-threatening maternal and fetal complications. Percutaneous coronary intervention is associated with low success rate and high likelihood of complications, and coronary artery bypass surgery is often required. Recurrent ischemic events because of persistent or new spontaneous coronary artery dissection are common during long-term follow-up.
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Affiliation(s)
- Ofer Havakuk
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Sorel Goland
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Anil Mehra
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Uri Elkayam
- From the Division of Cardiovascular Medicine, Department of Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles.
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7
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Rose E, Gedela M, Miller N, Carpenter PL. Pregnancy-Related Spontaneous Coronary Artery Dissection: A Case Series and Literature Review. J Emerg Med 2017; 52:867-874. [PMID: 28396082 DOI: 10.1016/j.jemermed.2017.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 02/04/2017] [Accepted: 02/25/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiac emergencies during pregnancy are rare but have significant associated morbidity and mortality when they do occur. The emergency physician must not only be aware of potentially life-threatening conditions in the pregnant woman, but also know the emergent management and treatment of these conditions to avoid worsening of the underlying condition. Pregnancy-related spontaneous coronary artery dissection has been described in the cardiology literature, but is not well-known in emergency medicine literature. CASE SERIES We present a case series of six previously healthy women ages 27 to 39 years who presented 1 to 75 days after delivery with spontaneous coronary artery dissection. The left main coronary was involved in 5 of 6 cases. One patient died, 5 survived. Two survivors maintained significant long-term disability. The patient that died had the diagnosis made on autopsy, the others were diagnosed with coronary angiography. Two patients were treated with stents, 2 with coronary artery bypass surgery, and 2 with medical management. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergent coronary catheterization is indicated if this diagnosis is suspected. However, emergency care teams must also understand how and why management including coronary artery catheterization can exacerbate the underlying condition. The role of coronary artery computed tomography remains unknown, although it exposes the fetus to significant radiation if the woman is still pregnant at presentation. Medical management is indicated with diffuse or distal disease as pregnancy-related coronary artery dissections often resolve with time. Localized discrete lesions may be stented. Coronary artery bypass graft surgery may be considered if the left main artery is involved or there are multiple proximal lesions. Cardiac transplantation is indicated rarely.
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Affiliation(s)
- Emily Rose
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, LAC+USC Medical Center, Los Angeles, California
| | - Maheedhar Gedela
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Nathan Miller
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Paul L Carpenter
- Department of Cardiology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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8
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Mokhberi V, Bagheri B, Navidi S, Amini SM. Spontaneous Coronary Artery Dissection: A Case Report. J Tehran Heart Cent 2015; 10:159-62. [PMID: 26697091 PMCID: PMC4685374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare and important cause of acute coronary syndrome and sudden cardiac death. Various etiologies are thought to be responsible for this condition, among which underlying atherosclerosis seems to be the most common. SCAD is predominant in women and is usually diagnosed via coronary artery angiography. Therapeutic interventions include medical therapy, percutaneous coronary artery intervention, and surgery based on lesion characteristics. We describe a 36-year-old woman with SCAD presenting with acute chest pain to Fatemeh-Zahra Hospital, Sari, Iran. The patient had no current atherosclerosis risk factors and had given birth 6 months previously. Coronary angiography was performed due to the persistence of the chest pain after initial management, and a spontaneous dissection of the left anterior descending artery was observed. She underwent coronary artery bypass graft and was discharged in good condition.
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Affiliation(s)
| | | | | | - Seyed Mohammad Amini
- Corresponding Author: Seyed Mohammad Amini, Fatemeh-Zahra Hospital, Mazandaran Heart Center, Artesh Boulevard, Sari, Iran. 4818813771. Tel:+98 11 33323023-5. Fax: +98 11 33328484. .
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9
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Afzal AM, Sarmast SA, Weber NA, Schussler JM. Spontaneous coronary artery dissection in a 22-year-old man on lisdexamfetamine. Proc (Bayl Univ Med Cent) 2015; 28:367-8. [PMID: 26130892 DOI: 10.1080/08998280.2015.11929277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of coronary events and sudden cardiac death. SCAD can present with a wide spectrum of clinical presentations and as an entity remains underrecognized. Several risk factors, such as female gender, peripartum and early postpartum state, and atherosclerotic disease, have been attributed to SCAD. Amphetamine use has been attributed to an increased risk for coronary artery events. We present a case of a 22-year-old man on lisdexamfetamine and no other significant medical history who presented with SCAD and was successfully treated with medical management.
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Affiliation(s)
- Aasim M Afzal
- Department of Internal Medicine (Afzal) and Division of Cardiology (Sarmast, Schussler), Baylor University Medical Center at Dallas and Baylor Hamilton Heart and Vascular Hospital; and Texas A&M College of Medicine (Schussler); and the University of Texas at Austin (Weber)
| | - Syed A Sarmast
- Department of Internal Medicine (Afzal) and Division of Cardiology (Sarmast, Schussler), Baylor University Medical Center at Dallas and Baylor Hamilton Heart and Vascular Hospital; and Texas A&M College of Medicine (Schussler); and the University of Texas at Austin (Weber)
| | - Nicholas A Weber
- Department of Internal Medicine (Afzal) and Division of Cardiology (Sarmast, Schussler), Baylor University Medical Center at Dallas and Baylor Hamilton Heart and Vascular Hospital; and Texas A&M College of Medicine (Schussler); and the University of Texas at Austin (Weber)
| | - Jeffrey M Schussler
- Department of Internal Medicine (Afzal) and Division of Cardiology (Sarmast, Schussler), Baylor University Medical Center at Dallas and Baylor Hamilton Heart and Vascular Hospital; and Texas A&M College of Medicine (Schussler); and the University of Texas at Austin (Weber)
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10
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D'Ovidio C, Sablone S, Carnevale A. Spontaneous coronary artery dissection: case report and literature review. J Forensic Sci 2015; 60:801-6. [PMID: 25678077 DOI: 10.1111/1556-4029.12722] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/26/2014] [Accepted: 05/22/2014] [Indexed: 11/28/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction and sudden cardiac death. It occurs most commonly in otherwise healthy women during pregnancy or the postpartum period. The true incidence of SCAD is underestimated, as most cases are diagnosed at autopsy. The pathophysiology of SCAD is still not fully understood, and its management can be challenging. This report describes a 35-year-old pregnant female who presented with an acute antero-lateral ST elevation secondary to spontaneous dissection of the left anterior descending artery and the circumflex artery. The diagnosis was established by coronary artery angiography. However, the patient died following cardiac tamponade. The examination of this case represented a starting point for the reviewing of the diagnosis, clinical course, and management of SCAD, and for the placing of this in context with the existing literature. This study highlights the importance of prompt diagnosis and subsequent lifesaving treatment.
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Affiliation(s)
- Cristian D'Ovidio
- Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Via dei Vestini, 31, 66100, Chieti, Italy
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11
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Elkayam U, Jalnapurkar S, Barakkat MN, Khatri N, Kealey AJ, Mehra A, Roth A. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Circulation 2014; 129:1695-702. [PMID: 24753549 DOI: 10.1161/circulationaha.113.002054] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Uri Elkayam
- Department of Medicine, Division of Cardiovascular Diseases and the Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles (U.E., S.J., M.N.B., N.K., A.M.); Department of Cardiac Sciences, Foothills Medical Centre University of Calgary, Calgary, AB, Canada (A.J.K.); and Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel (A.R.)
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12
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Lin AH, Shutt BJ, Dendall RT, Bennett W. Multivessel spontaneous coronary artery dissection treated with staged percutanous coronary intervention in a non-postpartum female. BMJ Case Rep 2012; 2012:bcr-2012-007274. [PMID: 23220437 DOI: 10.1136/bcr-2012-007274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 43-year-old woman who presented with a non-ST elevation myocardial infarction. During her first cardiac catheterisation, she was diagnosed with a chronic total occlusion of the right coronary artery and a flow limiting dissection of her middle left anterior descending artery. The dissection of the left anterior descending artery was stented with two overlapping everolimus-eluting stents. There were no complications from this percutaneous coronary intervention. On the following day, the patient continued to have persistent chest pain and returned to the catheterisation laboratory. It was then found that the patient had a total occlusion of the right coronary artery secondary to dissection. This was also stented with three everolimus-eluting stents with excellent clinical and angiographic results. It is important to consider spontaneous multivessel coronary dissections which can be treated successfully with percutaneous coronary intervention.
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Affiliation(s)
- Andrew H Lin
- Department of Cardiology, Naval Medical Center San Diego, San Diego, CA, USA.
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13
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Besinger BR, Gardner S. Spontaneous coronary artery dissection in a 27-year-old woman. J Emerg Med 2012; 44:e239-42. [PMID: 22917653 DOI: 10.1016/j.jemermed.2012.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 03/18/2012] [Accepted: 07/03/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) causes acute coronary syndromes or sudden death in young patients who are often lacking classic coronary disease risk factors. Systemic inflammatory and connective tissue diseases have been suggested as risk factors for SCAD. OBJECTIVE To review the risk factors, diagnosis, and management of this uncommon but life-threatening disease. CASE REPORT We report a case of a 27-year-old woman with a history of an ill-defined inflammatory arthropathy who presented with an acute ST-elevation myocardial infarction. SCAD was diagnosed by coronary angiography. Percutaneous coronary intervention was attempted but was unsuccessful. The patient recovered uneventfully with medical management and was ultimately diagnosed with systemic lupus erythematosus. CONCLUSIONS SCAD is a rare but important cause of acute coronary syndromes and sudden death. It commonly occurs in young women. Although pregnancy is the most well-established risk factor, systemic inflammatory and connective tissue diseases have also been suggested as risk factors.
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Affiliation(s)
- Bart R Besinger
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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14
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Sheikh AS, O’Sullivan M. Pregnancy-related Spontaneous Coronary Artery Dissection: Two Case Reports and a Comprehensive Review of Literature. Heart Views 2012; 13:53-65. [PMID: 22919449 PMCID: PMC3424780 DOI: 10.4103/1995-705x.99229] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, particularly seen in women during pregnancy or in the puerperium. It has a high acute phase mortality. The etiology is uncertain. Hormonal changes during pregnancy, hemodynamic stress and changes in the autoimmune status have been considered as possible etiological factors. A timely diagnosis and institution of appropriate treatment is important for a successful outcome. There is no consensus of opinion for optimal treatment. Conservative management, coronary artery bypass graft surgery, and percutaneous coronary intervention, all have been described in the literature as possible therapeutic options. Spontaneous coronary artery dissection should be considered as a differential in any young woman presenting with chest pain associated with pregnancy. We report two cases of pregnancy-associated spontaneous coronary artery dissection, both successfully managed, along with a comprehensive review of the previously published literature.
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Affiliation(s)
- Azeem S Sheikh
- Department of Cardiology, Southend University Hospital NHS Foundation Trust, Essex, UK
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15
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Brantley HP, Cabarrus BR, Movahed A. Spontaneous multiarterial dissection immediately after childbirth. Tex Heart Inst J 2012; 39:683-686. [PMID: 23109768 PMCID: PMC3461663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Spontaneous coronary artery dissection and vertebral artery dissection are rare, life-threatening conditions. The pathophysiology of spontaneous coronary artery dissection during the peripartum period is poorly understood. We present a case of spontaneous multivessel dissection in a 32-year-old postpartum woman who presented with neck and chest pain. The patient's coronary and vertebral artery dissections were diagnosed with use of multiple imaging methods, and dissection of the internal mammary artery was discovered during surgery. The patient underwent successful coronary artery bypass grafting and remained asymptomatic 2 years later. To our knowledge, this is the first report of simultaneous coronary, vertebral, and internal mammary artery dissection in a postpartum woman. Early recognition and treatment is crucial, given the high mortality rate associated with spontaneous dissection.
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Affiliation(s)
- Hutton P Brantley
- Department of Cardiovascular Sciences, Brody School of Medicine at East Carolina University, Greenville, North Carolina 27834, USA.
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16
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Pillow MT, Nguyen NA, Kuo D. Cardiac arrest from postpartum spontaneous coronary artery dissection. West J Emerg Med 2011; 12:567-70. [PMID: 22224163 PMCID: PMC3236138 DOI: 10.5811/westjem.2011.4.2263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 04/12/2011] [Accepted: 04/15/2011] [Indexed: 11/21/2022] Open
Abstract
We present the case of a 32-year-old woman who presented to the emergency department with a witnessed cardiac arrest. She was otherwise healthy with no cardiac risk factors and had undergone an uneventful repeated cesarean section 3 days priorly. The patient underwent defibrillation, out of ventricular fibrillation to a perfusing sinus rhythm, and was taken to the catheterization laboratory where coronary angiography findings showed spontaneous dissection of the left anterior descending artery. The patient received a total of 6 stents during her hospital stay and was eventually discharged in good condition. Spontaneous coronary artery dissection is a rare entity with a predilection for pregnant or postpartum women. Early diagnosis and treatment are key for survival, and when identified early, mortality rate is reduced.
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Affiliation(s)
- Malford T Pillow
- Baylor College of Medicine, Section of Emergency Medicine, Houston, Texas
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17
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Ducas R, Jassal DS, Hussain F. A case of circumferential multi-vessel coronary intramural hematoma in a post-menopausal woman. Heart Int 2011; 6:e10. [PMID: 22049309 PMCID: PMC3205786 DOI: 10.4081/hi.2011.e10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 08/13/2011] [Accepted: 08/19/2011] [Indexed: 11/22/2022] Open
Abstract
Spontaneous coronary dissections are a well described entity which are often difficult to treat. Intramural hematoma is one type of coronary dissection. Previous case reports have described the treatment for angiographically visible dissection. We describe the first report of diffuse intramural hematoma visualized only on intravascular ultrasound with no angiographically obvious evidence of dissection treated with multivessel drug eluting stenting. This case highlights the importance of a high level of suspicion and atypical presentations of coronary dissection, and the use of multimodality imaging with intravascular ultrasound and computerized tomography for both diagnosis and therapy.
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Pabla JS, John L, McCrea WA. Spontaneous coronary artery dissection as a cause of sudden cardiac death in the peripartum period. BMJ Case Rep 2010; 2010:2010/nov30_1/bcr0520102994. [PMID: 22798305 DOI: 10.1136/bcr.05.2010.2994] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare cause of acute coronary syndromes and can be potentially fatal. The authors describe a case of multi-vessel coronary artery dissection occurring in a young postpartum mother. The diagnosis was established by coronary artery angiography. However, the patient died following a cardiac arrest. The authors discuss the methods of investigation available and the different treatment options.
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Ghosh P, Pillay S, Khan S, Chauhan A. Spontaneous Coronary Artery Dissection in a Pre- Menopausal Woman Occurring Just prior to Menstruation. APOLLO MEDICINE 2010. [DOI: 10.1016/s0976-0016(12)60010-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Azzarelli S, Fiscella D, Amico F, Giacoppo M, Argentino V, Fiscella A. Multivessel spontaneous coronary artery dissection in a postpartum woman treated with multiple drug-eluting stents. J Cardiovasc Med (Hagerstown) 2009; 10:340-3. [PMID: 19430346 DOI: 10.2459/jcm.0b013e3283276dee] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Multivessel spontaneous coronary artery dissection is a very rare cause of myocardial ischemia. Its optimal treatment is not yet well defined and is usually tailored to clinical features. We report a case of a postpartum woman with multivessel spontaneous coronary artery dissection and acute myocardial infarction, in whom the drug-eluting stenting of the only alleged 'culprit' vessel did not prevent the propagation of dissection from another vessel. Although the recommendations drawn from a single case report are not conclusive, we believe that when there is a multivessel spontaneous coronary artery dissection in a setting of acute myocardial infarction, all dissected coronary segments should be treated using stents.
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