When this happens the artery narrows, and blood flow to part of the heart muscle decreases or stops. Formerly depicted in case reports or small case series and considered a rare entity, contemporary series have. Ongoing research has provided a few clues on potential causes. Within the past 5 years, recognition of spontaneous coronary artery dissection scad as a cause of acute coronary syndrome acs and sudden cardiac death scd has improved 11. Scad which stands for spontaneous coronary artery dissection happens when one or more of the inner layers of a coronary artery tears away from the outer layer.
Coronary artery disease accepts manuscript submissions through a submission service on another website. Seek help immediately if you think you are experiencing a heart attack, particularly if. Learn vocabulary, terms, and more with flashcards, games, and other study tools. We present an unusual woven case involving all coronary arteries and two patient with scad. Cad is the single most frequent cause of death in developed countries, causes about 1 in every 5 deaths. Spontaneous coronary artery dissection university of ottawa. Spontaneous coronary artery dissection scad is increasingly recognized as an important cause of myocardial infarction mi, particularly in young women. Scad is predominant in women and is usually diagnosed via coronary artery. Outcomes of patients with spontaneous coronary artery dissection. Of those treated conservatively n4, 3 required revascularization for scad extension, and all 79 who had repeat angiogram. You can decrease your chances of a stent problem or more coronary artery disease elsewhere in the heart by maintaining an ideal body weight. Scad can be diagnosed in patients undergoing coronary angiography and can be underestimated.
Two pathogenetic mechanisms have been proposed to explain scad. Introduction among the general population, spontaneous coronary artery dissection scad is a very uncommon cause of myocardial infarction. Various etiologies are thought to be responsible for this condition, among which underlying atherosclerosis seems to be the most common. Outcomes of patients with spontaneous coronary artery. An unusual case of spontaneous multi vessel coronary artery. A 65 yearold woman with hypertension and parkinsons disease presented with sudden onset severe chest pain. Spontaneous coronary artery dissection scad is an increasingly recognized cause of myocardial infarction mi, particularly affecting young women. Scad should be considered in the differential diagnosis of acute chest pain patients, with heightened clinical suspicion in young female patients under age 50 who present like acs. Spontaneous coronary artery dissection springerlink. The heart normally extracts 70 to 75 percent of the available oxygen from the blood in coronary circulation, which is much more than the amount extracted by other organs from their circulationse.
We present a case of scad in an otherwise healthy 26 yearold male who had been experiencing chest pain during and after sports activity. Spontaneous coronary artery dissection scad is an infrequent and often missed diagnosis especially in women presenting with acute coronary syndrome acs. A torn blood vessel in the heart can cause a heart attack. Abstract background spontaneous coronary artery dissection scad. Scad is defined as a tear in the coronary arterial wall that is not related to trauma or medical instrumentation. Section editors juan carlos kaski, dsc, md, dm hons, frcp, fesc, facc, faha section editor coronary heart disease. Double vessel extension of spontaneous left main coronary artery dissection in young women treated with thrombolytics. One such condition, spontaneous coronary artery dissection scad, is an uncommon and malefic presentation of coronary artery disease that can lead to myocardial infarction and sudden death. Spontaneous coronary artery dissection scad is a rarely reported cause of myocardial infarction mi, arrhythmias and sudden cardiac death scd. It occurs most commonly in young women in the left anterior descending coronary artery. Scad can result in significant morbidities such as myocardial ischemia and infarction. This entity requires the ruling out of possible associated systemic pathologies and a targeted therapeutic approach, being correlated with a favorable longterm prognosis.
Spontaneous coronary artery dissection scad is a rare and important cause of acute coronary syndrome and sudden cardiac death. This book has wide geography both literally and figuratively. Spontaneous coronary artery dissection scad a rare condition that can cause a heart attack. Spontaneous coronary artery dissection scad symptoms. This book is distributed under the terms of the creative commons.
It was first described in 1931 following the autopsy of a 42yearold woman who died suddenly. Spontaneous coronary artery dissection scad is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome acs. Spontaneous coronary artery dissection scad circulation. Spontaneous coronary artery dissection is a rare diagnosis with high potential for mortality or significant morbidity. The coronary arteries can constrict as a response to various stimuli, mostly chemical. Spontaneous coronary artery dissection is a rare cause of infarction in the general population, but a common cause of myocardial infarction during pregnancy, and even nowadays carries a high risk. First of all, this book brings together contributions from around the world, both from postindustrial countries and developing world. Obstruction of a coronary artery, depriving the heart tissue of oxygenrich. Spontaneous coronary artery dissection, scad, is a rare cause of acute coronary syndrome and has an indistinguishable presentation from acs due to plaque rupture. It is defined as a nontraumatic, noniatrogenic, and nonatherosclerotic separation of the coronary arterial wall by intramural hematoma, resulting in a false lumen with or without intimal tear. Spontaneous coronary artery dissection scad is a separation of the coronary wall layers, not related to trauma, medical procedures or atherosclerosis. A few of the previously reported woven coronary artery cases have involved in a single coronary artery. Beat scads mission is to increase awareness of a coronary condition that is currently underdiagnosed.
A heart attack that occurs in scad is different from a heart attack caused by. Diagnosis of spontaneous coronary artery dissection by. This tear can slow or block blood flow to the heart which can cause damage to the heart muscle or affect the normal heart rhythm. 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 rare and important cause of acute coronary syndrome and sudden. An untimely wear and tear a case of spontaneous coronary. Over the last 5 years, more robust evidence has become available. Spontaneous coronary artery dissection scad is defined as a nontraumatic and noniatrogenic separation of the coronary artery walls, creating a false lumen and intramural hematomas leading to decreased blood flow and myocardial ischemia. This spontaneous tear can result from a disruption of the innermost lining of the arterial wall, causing blood to rush in from the lumen center channel of the artery.
It is an uncommon and poorly understood cause of acute coronary syndrome acs, myocardial. Scad is thought to be caused by hemorrhage within the vessel wall, leading to separation of its layers. Management of spontaneous coronary artery dissection in the primary percutaneous coronary intervention era. Coronary artery disease ebook by 9781447128281 rakuten kobo. The dissection causes the blood entry in the vascular wall with the consequent formation of a false lumen and intramural hematoma imh. Blood is able to flow into the space between the layers and a blood clot forms, reducing the flow of blood through the artery. An intimal flap generating 2 lumens true and false lumen provides the angiographic. We report an unusual case of multi vessel spontaneous coronary artery dissection in an elderly woman with successful medical management. Spontaneous coronary artery dissection in acute coronary. May 23, 2016 spontaneous coronary artery dissection is an important etiology of nonatherosclerotic acute coronary syndrome, myocardial infarction, and sudden death. Spontaneous coronary artery dissection scad and woven coronary artery anomaly wcaa are relatively rare. Spontaneous coronary artery dissection scad symptoms and. Spontan koroner arter diseksiyonu nedenli nstemi nstemi due to spontaneous coronary artery dissection 2 introduction angiographic studies have reported the incidence of spontaneous coronary artery dissection scad to be between 0.
We report the first case of true spontaneous coronary artery dissection scad with an intimal flap as a very rare manifestation of as. Overall, 6 of 168 patients had coronary artery bypass surgery and 33 of 168 had percutaneous coronary intervention inhospital. Causes of spontaneous coronary artery dissection stanford. It often affects people who are young, active, otherwise healthy, and largely free of the typical risks for heart disease. Spontaneous coronary artery dissection sometimes referred to as scad. Spontaneous coronary artery dissection is a rare, but very important clinical phenomenon usually described as an uncommon cause of an acute coronary artery syndrome. Spontaneous coronary artery dissection is a rare differential diagnosis should be considered in the presence of acute coronary syndrome. Coronary artery dissection statpearls ncbi bookshelf. List of books and articles about coronary heart disease. A challenging case of spontaneous coronary artery dissection. Postpartum multivessel spontaneous coronary artery dissection. Spontaneous coronary artery dissection and its association with. Medline abstract for reference 12 of spontaneous coronary. Insights into spontaneous coronary artery dissection jacc.
Learn more about the causes, symptoms, diagnosis and treatment from the number one heart center, cleveland clinic. Spontaneous coronary artery dissection scad is an uncommon occurrence. Incidence and characterisation of spontaneous coronary artery dissection as a cause of acute coronary syndromea singlecentre australian experience. Coronary artery disease will offer todays most uptodate, userfriendly guidance on the evaluation, diagnosis, and medical and surgical treatment of this most important aspect of cardiovascular disease and will be on the wish list for every trainee and practicising cardiologist, cardiac surgeon, vascular surgeon, diabetologist, cardiac radiologist and any physician. A familial association in spontaneous coronary artery dissection, a type of heart attack that most commonly affects younger women, has been identified by researchers, suggesting a genetic. Spontaneous coronary artery dissection scad can be defined as the.
Scad is an infrequent cause of acute coronary syndrome acs, especially in young women presenting with mi. Scad can slow or block blood flow to the heart, causing a heart attack, abnormalities in heart rhythm or sudden death. The successfully accomplished surgery demonstrates, in this case, to be the only possible way of a cure. Humphries, dscb abstract spontaneous coronary artery dissection scad is gaining recognition as an important cause of myocardial infarction. Spontaneous coronary artery dissection scad is a rare but challenging clinical entity of unknown etiology.
Another procedure is coronary artery bypass surgery, which splices veins or internal mammary arteries to the affected coronary artery in order to bypass the atherosclerotic blockage and supply blood to the heart muscle. How to approach a spontaneous coronary artery dissection. From a pathophysiological standpoint, scad may occur in patients with a coronary intimal tear presenting with the classic angiographic flap and multiple lumens, but also in patients without an intimal rupture presenting as an intramural hematoma. Check out these bestsellers and special offers on books and newsletters from mayo clinic. Chronic coronary artery disease 9780323428804 elsevier. Spontaneous coronary artery disease identified as inherited. Unfortunately, scad can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and. Spontaneous coronary artery dissection scad is commonly overlooked in patients presenting with acute coronary syndrome acs. There has been little systematic research to date into scad. Tearing of the coronary artery wall tearing of the coronary artery wall is rare. Spontaneous coronary artery dissection scad is a rare condition that commonly presents as an acute coronary event in the younger population, especially in females of childbearing age.
The causes of spontaneous coronary artery dissection scad remain unknown. Spontaneous coronary artery dissection scad is a rare and often lethal cause of acute coronary syndrome, which typically affects young women and otherwise healthy individuals. Spontaneous coronary artery dissection scad disease. Seek help immediately if you think you are experiencing a heart attack, particularly if you feel chest pain. 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. 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. This is natural, because coronary artery disease is becoming pandemic worldwide. Apr 02, 2019 another procedure is coronary artery bypass surgery, which splices veins or internal mammary arteries to the affected coronary artery in order to bypass the atherosclerotic blockage and supply blood to the heart muscle.
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. Today, he is in severe distress and is reporting crushing chest discomfort. A challenging case of spontaneous coronary artery dissection abhisekh mohanty dm cardiology department of cardiology, continental hospitals, hyderabad, india abhisekh. The american heart association explains the sometimes a heart attack is not just. Pdf spontaneous coronary artery dissection and acute. Mar 23, 2015 a familial association in spontaneous coronary artery dissection, a type of heart attack that most commonly affects younger women, has been identified by researchers, suggesting a genetic.
Spontaneous coronary artery dissection and woven coronary. Those instructions and guidelines are readily available on the submission service site. A 45yearold man had coronary artery stents placed 2 days ago. The tearing cause heart attack by spontaneous coronary. Coronary artery disease has specific instructions and guidelines for submitting articles. Spontaneous coronary artery dissection scad has been reported across a wide age range 1884 years but the majority of cases are in young to middleaged women. How and when to suspect spontaneous coronary artery dissection. 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. Unlike cad, spontaneous coronary artery dissection is not due to. Symptoms of spontaneous coronary artery dissection scad. Innovations in the catheterization laboratory including optical coherence tomography and intravascular ultrasound have enhanced the ability to visualize intimal disruption and intramural hematoma associated with scad.
Spontaneous coronary artery dissection scad is a rare emergency condition that occurs when a tear forms in one of the blood vessels in the heart. Spontaneous coronary artery dissection scad is a nontraumatic and noniatrogenic injury occurring in the coronary vessel wall. Sherrid mv, mieres j, mogtader a, et al onset during exercise of spontaneous coronary artery dissection and sudden death. Coronary angiography represents the classical diagnostic tool in patients with scad 27. His radial pulse is very weak, blood pressure is 6440 mmhg, respiratory rate is 28 breathsmin, and oxygen saturation is 89% on room air. Mode of delivery for a term patient with spontaneous coronary artery dissection cheryl yondorf, arnold cohen einstein medical center philadelphia, 5501 old york road, philadelphia pa 1914, usa 1. Multivessel spontaneous coronary artery dissection in an. 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.
The patient was transferred to the operating room, where. Treatment for scad patients differs from other heart attack patients, who may. Acute coronary syndrome due to spontaneous coronary. There is also a rare condition known as spontaneous coronary artery dissection, in which the wall of one of the coronary arteries tears, causing severe pain. One case report described intramural hematoma of the coronary artery.
Score system approach to diagnose and manage spontaneous. Spontaneous coronary artery dissection known as scad happens when one or more of the inner layers of a coronary artery tears away from the outer layer. It is caused by either a primary intimal dissection or a primary hematoma in the medial layer. Spontaneous coronary artery dissection scad is a rare cause of acute coronary syndromes and as such, although many cases are described, there remains little reliable information on the epidemiology, optimal clinical and interventional management and outcomes of this condition. Sometimes a coronary artery temporarily contracts or goes into spasm. Spontaneous coronary artery dissection scad remains an elusive clinical condition of unknown aetiology 8 decades after its initial pathological description 1. How and when to suspect spontaneous coronary artery. A cold laser may be used to remove atherosclerotic plaques with bursts of ultraviolet light. Spontaneous coronary artery dissection scad is gaining recognition as an important cause of myocardial infarction, especially in young women. Sudden death accounts for the majority of presentations. Mode of delivery for a term patient with spontaneous coronary. Spontaneous coronary artery dissection sciencedirect. Spontaneous coronary artery dissection scad is a rare clinical entity that frequently presents as an acute coronary syndrome 1, 2, 3, 4. Spontaneous coronary artery dissection is a rare coronary pathology whose precise incidence, etiology, pathogenesis, treatment and evolution have not been clearly established.
Various etiologies are thought to be responsible for this condition, among which underlying atherosclerosis. This should be differentiated from atherosclerotic dissections, which result from. It is defined as a spontaneous tear in the coronary arterial wall that is not traumatic or iatrogenic. Comprehensive coverage starts with the basic pathophysiologic mechanisms of the disease, including molecular and genetic mechanisms, cells interaction and. 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. Aortic and aortic valve pathologies have been described as extrarenal manifestations of as in multiple case reports. Spontaneous coronary artery dissection request pdf. Aug 19, 2009 spontaneous coronary artery dissection is an uncommon cause of acute coronary syndrome and sudden cardiac death. Author jacqueline saw, md, frcpc, facc clinical professor university of british columbia vancouver general hospital.
Spontaneous coronary artery dissection scad develops without warning and is usually diagnosed after causing a heart attack or sudden cardiac arrest. Spontaneous coronary artery dissection is very rare, but about a third of the woman with this diagnosis are in their peripartum or postpartum period. Au krittanawong c, kumar a, virk huh, yue b, wang z. Jul 03, 2015 spontaneous coronary artery dissection scad is a rare and important cause of acute coronary syndrome and sudden cardiac death. From biology to clinical practice links the most important basic concepts of atherosclerosis pathophysiology to treatment management of coronary artery disease. The incident case in a 42yearold woman was diagnosed at autopsy in 1931 1. This leads to a separation and weakening of the walls of the artery.
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