scholarly journals Atherosclerotic spontaneous coronary artery dissection (A-SCAD) in a patient with COVID-19: case report and possible mechanisms

2020 ◽  
Vol 4 (FI1) ◽  
pp. 1-6 ◽  
Author(s):  
Remo Albiero ◽  
Giuseppe Seresini
Keyword(s):  
Coronary Artery ◽  
Vascular Inflammation ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Culprit Lesion ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Case Summary ◽  
Susceptible Patient ◽  
History Of

Abstract Background Spontaneous coronary artery dissection (SCAD) may be atherosclerotic (A-SCAD) or non-atherosclerotic (NA-SCAD) in origin. Contemporary usage of the term ‘SCAD’ is typically synonymous with NA-SCAD. COVID-19 could induce a vascular inflammation localized in the coronary adventitia and periadventitial fat and contribute to the development of an A-SCAD of a vulnerable plaque in a susceptible patient. Case summary In this report we describe a case of a COVID-19 patient with past cardiac history of CAD who was admitted for acute coronary syndrome (ACS). Coronary angiography demonstrated the culprit lesion in the proximal LAD that presented with a very complex and unusual morphology, indicative of an A-SCAD. The diagnosis of A-SCAD was supported by the presence of a mild stenosis in the same coronary segment in the last angiogram performed 3 years previously. He was successfully treated by PCI, had a favourable course of the COVID-19 with no symptoms of pneumonia, and was discharged from the hospital after two negative tests for SARS-CoV-2. Discussion A higher index of suspicion of A-SCAD is needed in patients with suspected or confirmed COVID-19 presenting with ACS. The proposed approach with ‘thrombolysis first’ for treating STEMI patients with suspected or confirmed COVID-19 infection could be unsafe in the case of underlying A-SCAD.

scholarly journals Wild at heart: 34-year-old male with new onset dyspnea, heart failure and history of amphetamine use; a case report

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Hossein Navid ◽  
Hamidreza Soleimani ◽  
Kaveh Hosseini
Keyword(s):  
Coronary Artery ◽  
Ischemic Cardiomyopathy ◽  
Systolic Dysfunction ◽  
Young Female ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Expert Opinions ◽  
History Of

Abstract Background Spontaneous coronary artery dissection (SCAD) is a rather rare cause of acute coronary syndrome with a preponderance for young female patients. Amphetamines are now the second most widely used substance drugs in the world and they are associated with a myriad of cardiac diseases including cardiomyopathies and SCADs. There is much uncertainty regarding the best treatment strategy in such cases and decision-making remains mostly individualized and based on expert opinions. Case presentation A 34-year-old male with an unremarkable past medical history presented to a cardiologist with prominent dyspnea and orthopnea. He reported occasional methamphetamine use from 3 years before the presentation. An echocardiogram showed an enlarged left ventricle and severe systolic dysfunction with an ejection fraction of 10–15%. Coronary angiography revealed multiple linear dissections in both left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX). The patient’s right coronary artery (RCA) showed occlusion in the proximal segment. The patient was diagnosed with amphetamine-induced spontaneous coronary artery dissection and resultant ischemic cardiomyopathy. After thorough evaluation, medical treatment ensued. Conclusions Methamphetamine abusers have a 3.7 fold risk of developing some form of a cardiomyopathy in comparison to individuals without amphetamine abuse. Coronary artery dissection and increased thrombus burden are some of the mechanisms responsible for ischemic cardiomyopathy in these groups of patients.

Abstract 17378: Familial Spontaneous Coronary Artery Dissection - Evidence for Genetic Susceptibility

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kashish Goel ◽  
Marysia Tweet ◽  
Timothy M Olson ◽  
Joseph J Maleszewski ◽  
Rajiv Gulati ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Family Members ◽  
Case Series ◽  
Artery Dissection ◽  
High Morbidity ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
History Of

Background: Spontaneous coronary artery dissection (SCAD) typically presents as acute coronary syndrome in young women with no cardiovascular risk factors. It is associated with high morbidity and mortality, and is underdiagnosed. Despite this, risk factors and pathophysiology associated with SCAD are not completely understood. The objective of the present case series was to assess family history as a risk factor in patients with SCAD. Methods: We reviewed the medical records and questionnaires of 335 participants in the Mayo Clinic SCAD Registry for history of MI, SCAD or CAD in another family member. Coronary angiograms of all affected family members were reviewed by a senior interventional cardiologist. Results: We identified 4 familial cases of SCAD comprised of affected mother-daughter, identical twin sister, sister and aunt-niece pairs, implicating both recessive and dominant modes of inheritance. The mother-daughter pair also reported history of fatal MI in 3 maternal relatives including grandmother, great grandmother and great aunt. One of the affected twin sisters died of SCAD, which was confirmed on autopsy. None of the subjects had other potential risk factors for SCAD including extreme exercise, polycystic kidney disease, connective tissue disorder, peripartum status or diagnosed non-coronary fibromuscular dysplasia. The details of their demographics, risk factors, presentation, location of SCAD and management are presented in the table. Conclusions: This series is the first to identify a familial association in SCAD suggesting a genetic predisposition. Recognition of SCAD as a heritable disorder has implications for at-risk family members and furthers our understanding of the pathophysiology of this complex disease. Whole exome sequencing in these families provides a unique opportunity to identify the molecular underpinnings of SCAD susceptibility.

scholarly journals Case Report of an Acute Myocardial Infarction as a Result of Spontaneous Coronary Artery Dissection in a Patient with Fibromuscular Dysplasia

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
A. Kalinskaya ◽  
D. Skrypnik ◽  
A. Kostin ◽  
E. Vasilieva ◽  
A. Shpektor
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Fibromuscular Dysplasia ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Case Summary ◽  
Acute Mi

Background. Spontaneous coronary artery dissection (SCAD) is an underdiagnosed and rare cause of myocardial infarction (MI). SCAD is defined as the separation of the coronary artery wall by hemorrhage with or without intimal tear. It causes acute coronary syndrome in 1.7% to 4% of cases. Case Summary. We report a case of a patient with acute MI caused by SCAD with marked progression of dissection within 4 days and spontaneous healing in 2 months. Fibromuscular dysplasia (FMD) of the arteries is an associated condition of SCAD that was found in our patient. Conclusion. In young women admitted to the clinic with signs of acute myocardial infarction, SCAD should be suspected. FMD as an associated condition that should be ruled out in every SCAD patient. Conservative treatment of SCAD is the most preferable strategy.

scholarly journals Spontaneous Coronary Artery Dissection in a Patient with a Family History of Fatal Ascending Aortic Dissection: Case Report and Discussion of Diseases Causing Both Presentations

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
George Joy ◽  
Hany Eissa
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Family History ◽  
Aortic Dissection ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Arterial Tree ◽  
Coronary Syndrome ◽  
History Of

Background. Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). Aortic dissection and SCAD share common aetiologies such as a fibromuscular dysplasia (FMD), Marfan, Ehlers Danlos, and more rarely systemic lupus erythematosus and Loeys-Dietz; however, SCAD has never been known to have a familial association with aortic dissection. Case Summary. This case report describes a 48-year-old woman suffering from SCAD who had a mother who died from ascending aortic dissection in her 50s. Discussion. This is the first case report to our knowledge of a patient with SCAD with a first-degree relative with aortic dissection. Our case is interesting in that it shows that if predisposition to arterial dissection was inherited from mother to daughter, one of them suffered an extremely rare manifestation of their underlying disease. It also shows that a high index of suspicion is needed for SCAD in the presence of a patient with ACS and a family history of dissection elsewhere in the arterial tree.

scholarly journals A case report of recurrent spontaneous coronary artery dissection and Takotsubo cardiomyopathy: a treatment dilemma

2020 ◽  
Vol 4 (1) ◽  
pp. 1-6
Author(s):  
Hafiz U Ghafoor ◽  
Abhishek Bose ◽  
Amr El-Meligy ◽  
Joseph Hannan
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Takotsubo Cardiomyopathy ◽  
Clinical Risk Factor ◽  
Artery Dissection ◽  
Inferior Wall ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
History Of

Abstract Background Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome in younger females with no pre-existing history of coronary artery disease. 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. Current recommendations advise for a conservative approach in the absence of haemodynamic compromise and flow limitations. Conversely, there are no clear guidelines for the management of early recurrent SCAD. Case summary A 52-year-old woman with history of obesity, asthma, and prediabetes presented with chest pain and electrocardiogram (ECG) showing inferior wall ST-elevation myocardial infarction (STEMI). Coronary angiography revealed proximal right coronary artery (RCA) dissection and distal left anterior descending artery (LAD) dissection, while left ventriculogram showed Takotsubo cardiomyopathy (TC). Angiography revealed no flow limitations so conservative management was pursued. She returned within a couple of days with recurrent chest pain and ECG showing similar findings of inferior STEMI. Repeat angiography confirmed progression of the proximal RCA SCAD with resolution of distal LAD SCAD. Since flow through the distal RCA was still preserved, conservative medical management was continued. She presented a third time for palpitations only and another repeat coronary angiogram showed healing RCA SCAD. Discussion Management of early recurrent SCAD continues to be a clinical dilemma. In addition, our patient had features of TC which shares a similar clinical risk factor profile with SCAD thus it may be prudent to further investigate for TC in patients presenting with SCAD and have suggestive features of TC on history and echocardiography.

Spontaneous coronary artery dissection in association with cabergoline therapy

2021 ◽  
Vol 14 (2) ◽  
pp. e240022
Author(s):  
Zia Saleh ◽  
Susan Koshy ◽  
Vaninder Sidhu ◽  
Andrea Opgenorth ◽  
Janek Senaratne
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Cardiac Risk ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Ergot Derivative

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognised cause of acute coronary syndrome. While numerous risk factors are associated with SCAD, one potential cause is coronary artery vasospasm. The use of cabergoline—an ergot derivative and dopamine agonist that may induce vasospasm—has been associated with SCAD in one other case report worldwide. Here, we describe SCAD in a 37-year-old woman on long-term cabergoline therapy with no other cardiac risk factors. Cabergoline-induced SCAD should be considered in patients presenting with an acute coronary syndrome who are treated with this medication.

scholarly journals Recurrent Spontaneous Coronary Artery Dissection in 4 Vascular Territories

2018 ◽  
Vol 45 (2) ◽  
pp. 106-109
Author(s):  
Nader Makki ◽  
Poorvi Dalal ◽  
Quinn Capers ◽  
Ernest Mazzaferri ◽  
Talal Attar
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Premenopausal Women ◽  
Rare Condition ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Coronary Events ◽  
Multiple Episodes

Spontaneous coronary artery dissection, a rare cause of acute coronary syndrome, is due to nonatherosclerotic coronary events and is probably underrecognized as a cause of myocardial infarction. The condition typically affects premenopausal women who are otherwise healthy. Among more than 1,200 reported cases, recurrent dissection has been described 63 times, and only 3 reports have documented multiple episodes of dissection involving different vascular territories. We present the case of a woman in her 30s who, over a 9-year period, presented 4 times with coronary dissection in different vascular territories. She was first treated conservatively, then with stents, and ultimately by means of coronary artery bypass grafting. In addition to this case, we discuss this rare condition and its management.

scholarly journals P715 When "wait and see" is the best option: a case report of a spontaneous coronary artery dissection

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Castelo ◽  
T Silva ◽  
R Ramos ◽  
A Fiarresga ◽  
R Moreira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Luminal Narrowing ◽  
Angio Ct ◽  
Spontaneous Dissection

Abstract Introduction Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and is now being identified more frequently, in part because of increased awareness. Case report We present the case of a 63-year-old female, without cardiovascular risk factors or relevant past medical history. She complained of atypical chest pain in the last year. The patient was admitted due to acute chest pain at rest, hemodynamically stable, with unremarkable physical examination, including absence of heart failure signs. The EKG revealed a dynamic ST depression in leads V4-V6. The peak of high sensitivity troponin I was 13744pg/mL (ULN< 15.6) and CK 874U/l (ULN <168). The echocardiogram showed preserved left ventricular ejection fraction and hypokinesia of mid-apical segments of anterior wall. Considering the diagnosis of NSTEMI the patient underwent coronary angiography that revealed luminal narrowing of 70% in left main artery, 70% in proximal anterior descending artery (LAD) and 99% in first obtuse marginal. Given the absence of cardiovascular risk factors, the smooth angiographic appearance of coronary lesions and absence of calcium, we suspected of spontaneous dissection or vasculitis. Considering the absence of angina revascularization was delayed. A first coronary angio-CT confirmed the luminal narrowing and suggested a spontaneous dissection. Two weeks later the coronariography and the angio-CT were repeated with a significant improvement, showing only intermediate stenosis of proximal LAD. The additional imaging study revealed a 45mm ascending aortic dilation and a left primitive carotid stenosis without other vascular territory alterations, excluding fibromuscular dysplasia. The auto-immune study was unremarkable. With all these results it was assumed the diagnosis of a spontaneous coronary artery dissection and the patient was discharged asymptomatic under single antiplatelet therapy and Rivaroxaban. Three months later a new coronary angio-CT showed no significant coronary artery stenosis and the patient was asymptomatic. Discussion and conclusion The recognition of spontaneous coronary artery dissection is essential to the correct management of these cases because, unlike acute coronary syndrome due to atherosclerotic disease, the results of revascularization in these patients are suboptimal and conservative management is probably the best option. Abstract P715 Figure. angio-CT

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