Coronary artery dissection
| Coronary artery dissection | |
|---|---|
| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-10 | I25.4 |
| ICD-9-CM | 414.12 |
| DiseasesDB | 3115 |
| Patient UK | Coronary artery dissection |
A coronary artery dissection (also known as spontaneous coronary artery dissection, or SCAD) is a rare, sometimes fatal traumatic condition, with eighty percent of cases affecting women. The coronary artery develops a tear, causing blood to flow between the layers which forces them apart.[1] Early studies of the disease placed mortality rates at around 70% but more recent data indicate this figure may be closer to 18%.[2]
Contents
Signs and symptoms
The symptoms are often very similar to those of myocardial infarction (heart attack), with the most common being persistent chest pain.[3]
Causes
SCAD
There is evidence to suggest that a major cause of spontaneous coronary artery dissection (SCAD) is related to female hormone levels, as most cases appear to arise in pre-menopausal women, although there is evidence that the condition can have various triggers. Other underlying conditions such as hypertension, recent delivery of a baby, fibromuscular dysplasia and connective-tissue disorders (e.g., Marfan syndrome and Ehlers-Danlos syndrome) may occasionally result in SCAD.[4] There is also a possibility that vigorous exercise can be a trigger. However, many cases have no obvious cause.[5][6]
Pathophysiology
Coronary artery dissection results from a tear in the inner layer of the artery, the tunica intima. This allows blood to penetrate and cause an intramural hematoma in the central layer, the tunica media, and a restriction in the size of the lumen, resulting in reduced blood flow which in turn causes myocardial infarction and can later cause sudden cardiac death.[7][8]
Diagnosis
A selective coronary angiogram is the most common method to diagnose the condition, although it is sometimes not recognised until after death.[9] Intravascular ultrasound (IVUS) is also used as it is able to more easily differentiate the condition from atherosclerotic disease.[10]
Treatment
Treatment is varied depending upon the nature of the case. In severe cases, coronary artery bypass surgery is performed to redirect blood flow around the affected area.[11] Drug-eluting stents and thrombolytic drug therapy are less invasive options for less severe cases.[10]
Epidemiology
Eighty percent of cases are in women. [12]
See also
- Dissection (medical)
- Aortic dissection, a similar condition affecting a different artery
References
- ↑ Robert Slight; Ali Asgar Behranwala; Onyekwelu Nzewi; Rajesh Sivaprakasam; Edward Brackenbury; Pankaj Mankad (2003) "Spontaneous coronary artery dissection: a report of two cases occurring during menstruation" New Zealand Medical Journal]
- ↑ "Clinical course and long-term prognosis of spontaneous coronary artery dissection. "
- ↑ "Spontaneous Coronary Artery Dissection Postpartum"
- ↑ Dhawan R, Singh G, Fesniak H. (2002) "Spontaneous coronary artery dissection: the clinical spectrum". Angiology
- ↑ Mark V. Sherrid; Jennifer Mieres; Allen Mogtader; Naresh Menezes; Gregory Steinberg (1995) "Onset During Exercise of Spontaneous Coronary Artery Dissection and Sudden Death. Occurrence in a Trained Athlete: Case Report and Review of Prior Cases" Chest
- ↑ {http://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/basics/risk-factors/con-20037794}
- ↑ Virmani R, Forman MB, Rabinowitz M, McAllister HA (1984) "Coronary artery dissections" Cardiol Clinics
- ↑ Kamineni R, Sadhu A, Alpert JS. (2002) "Spontaneous coronary artery dissection: Report of two cases and 50-year review of the literature" Cardiol Rev
- ↑ C. Basso, G. L. Morgagni, G. Thiene (1996) "Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death" BMJ
- ↑ 10.0 10.1 Intravascular Ultrasound Imaging in the Diagnosis and Treatment: The Future: IVUS-Guided DES Implantation?
- ↑ MedHelp:Coronary artery dissection treatment
- ↑ Hayes, S (2013), New Insights into This Not-So-Rare Condition
