1
|
Martinez KA, Gudenkauf B, Ratchford EV, Kim ESH, Sharma G. Spontaneous coronary artery dissection: a focus on post-dissection care for the vascular medicine clinician. Front Cardiovasc Med 2024; 11:1352700. [PMID: 38572306 PMCID: PMC10989683 DOI: 10.3389/fcvm.2024.1352700] [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] [Received: 12/08/2023] [Accepted: 02/19/2024] [Indexed: 04/05/2024] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an uncommon condition which is increasingly recognized as a cause of significant morbidity. SCAD can cause acute coronary syndrome and myocardial infarction (MI), as well as sudden cardiac death. It presents similarly to atherosclerotic MI although typically in patients with few or no atherosclerotic risk factors, and particularly in women. As more patients are recognized to have this condition, there is a great need for clinician familiarity with diagnostic criteria, as well as with contemporary treatment approaches, and with appropriate patient-centered counseling, including genetic testing, exercise recommendations, and psychological care. The standard of care for patients with SCAD is rapidly evolving. This review therefore summarizes the diagnosis of SCAD, epidemiology, modern treatment, cardiac rehabilitation and preconception counseling, and the current approach to genetic testing, exercise recommendations, and psychological care, all of which are crucial to the vascular medicine specialist.
Collapse
Affiliation(s)
- Katherine A. Martinez
- Biochemistry Undergraduate Program, Loyola University Maryland, Baltimore, MD, United States
| | - Brent Gudenkauf
- The Texas Heart Institute Fellowship Program, Houston, TX, United States
| | - Elizabeth V. Ratchford
- Johns Hopkins Center for Vascular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Esther S. H. Kim
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte NC, United States
| | - Garima Sharma
- Johns Hopkins Center for Vascular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| |
Collapse
|
2
|
Bhanushali A, Kohli M, Prakash A, Sarvepalli SR, Pandey A, Odugbemi O, Reyaz N, Trambadia B, Reddy SA, Chauhan S, Desai R. Spontaneous coronary artery dissection-associated takotsubo syndrome: A systematic review of case reports. World J Cardiol 2023; 15:406-414. [PMID: 37771341 PMCID: PMC10523194 DOI: 10.4330/wjc.v15.i8.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/24/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is underdiagnosed and requires comprehensive angiographic findings. Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome (TTS) or exist simultaneously, making it challenging for clinicians to treat and manage. Case reports lack consolidated data. We examined SCAD-TTS case reports. AIM To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS. METHODS SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed, EMBASE, Scopus, and Google Scholar databases till January 2023. Case reports described demographics, comorbidities, imaging, management, and results. RESULTS Twelve articles about 20 female patients were analyzed. 30% of patients (n = 6, > 60 years) were elderly (mean age 56.2 ± 9.07 years, range 36-70 years). Canada has 9 cases, United States 3, Australia 3, Sweden 2, Japan, Denmark, and France 1. Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS. Nine had hypertension, 2 had hyperlipidemia, and 1 had prediabetes. 5 patients (25%) smoked. 10 (50%) troponin-positive myocardial infarction patients reported chest discomfort. 11 (55%) of 20 instances had TTS/SCAD. 12 (60%) of 20 patients exhibited ST elevation and 3 (15%) had T wave inversion on electrocardiogram. 19/20 patients had elevated troponin. 9 (45%) of 20 people had apical akinesis with TTS ballooning on cardiac imaging. All 20 exhibited echocardiographic wall motion abnormalities. 19 (95%) of 20 coronary angiography cases had SCAD. 10 of 19 SCAD patients had left anterior descending, 2 diagonal, and 2 left circumflex coronary artery involvement. 7 of 20 patients had left ventricular ejection fraction (LVEF) data. LVEF averaged 38.78 ± 7.35%. 5 (25%) of the 20 cases underwent dual antiplatelet therapy. Three (15%) of 20 cases experienced occasional ectopic ventricular complexes, Mobitz ll AV block, and paroxysmal atrial fibrillation. All 20 cases recovered and survived. CONCLUSION Given the clinical similarities and challenges in detecting TTS and SCAD, this subset needs more research to raise awareness and reduce morbidity.
Collapse
Affiliation(s)
- Aditi Bhanushali
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Muskan Kohli
- Department of Population Health & Leadership, University of New Haven, West Haven, CT 06516, United States
| | - Ananya Prakash
- Department of Medicine, Vydehi Institute of Medical Sciences and Research Center, Bangalore 560066, Karnataka, India
| | - Svaapnika Rao Sarvepalli
- Department of Population Health & Leadership, University of New Haven, West Haven, CT 06516, United States
| | - Anchal Pandey
- Department of Medicine, G.S.V.M. Medical College, Kanpur 208002, Uttar Pradesh, India
| | - Olufemi Odugbemi
- Department of Internal Medicine, Lincoln Medical and Mental Health Centre, Bronx, NY 10451, United States
| | - Nafisa Reyaz
- Department of Medicine, Jawaharlal Nehru Medical College & Hospital, Aligarh 202002, UP, India
| | - Bansi Trambadia
- Master of Public Health, Mount Sinai, New York, NY 10029, United States
| | | | - Shaylika Chauhan
- Department of Internal Medicine, Geisinger Health System, Wikes-Barre, PA 18702, United States.
| | - Rupak Desai
- Independent Researcher, Independent Researcher, Atlanta, GA 30079, United States
| |
Collapse
|
3
|
Smirnova A, Aliberti F, Cavaliere C, Gatti I, Vilardo V, Giorgianni C, Cassani C, Repetto A, Narula N, Giuliani L, Urtis M, Ozaki Y, Prati F, Arbustini E, Ferrari M. Spontaneous coronary artery dissection: an unpredictable event. Eur Heart J Suppl 2023; 25:B7-B11. [PMID: 37091648 PMCID: PMC10120938 DOI: 10.1093/eurheartjsupp/suad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is an under-recognized cause of acute coronary syndrome that predominantly affects women in adulthood and is the leading cause of acute myocardial infarction in pregnancy. The most common clinical presentation is ST-segment elevation myocardial infarction (STEMI) or non-STEMI, followed by cardiogenic shock (∼2%), sudden cardiac death (0.8% in autopsy series), cardiac arrest, ventricular arrhythmias (∼5%), and Takotsubo syndrome. The prevalence of SCAD in the general population is largely uncertain due to underdiagnosis. Oral contraceptives, post-menopausal therapy, and infertility treatments are recognized associated factors. The pathological substrates (fibromuscular dysplasia) and triggers (especially emotional stress) are commonly present in affected women. The few cases with a precise genetic aetiology occur in the context of syndromic and non-syndromic connective tissue diseases. The only true certainty in SCAD is the overwhelming prevalence in women. The first event as well as the recurrence (up to 30%, which varies depending on the definition) is largely unpredictable. The treatment strategy is highly individualized and requires extensive additional study in order to optimize outcomes and prevent major adverse cardiovascular events in affected individuals. We have known about SCAD for nearly a century, but we still do not know how best to prevent, diagnose, and treat it, making SCAD a highly important and unmet clinical need.
Collapse
Affiliation(s)
- Alexandra Smirnova
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Flaminia Aliberti
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudia Cavaliere
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Gatti
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Viviana Vilardo
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carmelina Giorgianni
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Obstetrics and Gynecology, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Alessandra Repetto
- Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Nupoor Narula
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Lorenzo Giuliani
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mario Urtis
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Francesco Prati
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
- Centro per la Lotta Contro L’Infarto—CLI Foundation, Rome, Italy
| | | | | |
Collapse
|
4
|
Cano-Castellote M, Afanador-Restrepo DF, González-Santamaría J, Rodríguez-López C, Castellote-Caballero Y, Hita-Contreras F, Carcelén-Fraile MDC, Aibar-Almazán A. Pathophysiology, Diagnosis and Treatment of Spontaneous Coronary Artery Dissection in Peripartum Women. J Clin Med 2022; 11:jcm11226657. [PMID: 36431134 PMCID: PMC9692787 DOI: 10.3390/jcm11226657] [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] [Received: 09/20/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an infrequent cause of nonobstructive ischemic heart disease in previously healthy young women and therefore is not usually considered in differential diagnoses. The overall incidence of SCAD in angiographic series is between 0.28 and 1.1%, with a clear predominance in young, healthy women (70%) of whom approximately 30% are in the postpartum period. In the United Kingdom, between 2008 and 2012, SCAD was the cause of 27% of acute myocardial infarctions during pregnancy, with a prevalence of 1.81 per 100,000 pregnancies. Regarding the mechanism of arterial obstruction, this may be due to the appearance of an intramural hematoma or to a tear in the intima of the arteries, both spontaneously. Although multiple diagnostic methods are available, it is suggested to include an appropriate anamnesis, an electrocardiogram in the first 10 min after admission to the service or the onset of symptoms, and subsequently, a CT angiography of the coronary arteries or urgent coronary angiography if the hemodynamic status of the patient allows it. Treatment should be individualized for each case; however, the appropriate approach is generally based on two fundamental pillars: conservative medical treatment with antiplatelet agents, beta-blockers, and nitrates, and invasive treatment with percutaneous coronary intervention for stent implantation or balloon angioplasty, if necessary.
Collapse
Affiliation(s)
- Marta Cano-Castellote
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | - Diego Fernando Afanador-Restrepo
- Faculty of Distance and Virtual Education, Antonio José Camacho University Institution, Santiago de Cali 760016, Colombia
- ZIPATEFI Research Group, Faculty of Health Sciences and Sports, University Foundation of the Área Andina, Pereira 660001, Colombia
| | - Jhonatan González-Santamaría
- ZIPATEFI Research Group, Faculty of Health Sciences and Sports, University Foundation of the Área Andina, Pereira 660001, Colombia
- Faculty of Health Sciences, Technological University of Pereira, Pereira 660001, Colombia
- Nutrition Sciences Postgraduate, Faculty of Nutrition Sciences, University of Sinaloa, Culiacan 80019, Mexico
| | | | | | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| |
Collapse
|