scholarly journals A Rare Case of Multivessel SCAD Successfully Treated with Conservative Medical Management

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Lance Alquran ◽  
Ankita Patel ◽  
Lucy Safi ◽  
Ankitkumar Patel
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Medical Management ◽  
Complete Resolution ◽  
Rare Case ◽  
Residual Disease ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Angiogram ◽  
Coronary Artery Dissection

A female patient presented with severe, symptomatic multivessel spontaneous coronary artery dissection (SCAD) with no known medical history or risk factors. The affected vessels were left anterior descending artery (LAD), right coronary artery (RCA), and the ramus. She was treated with conservative medical management. Two months later, repeat coronary angiogram to evaluate for any residual disease was performed which showed near-complete resolution of all involved vessels.

scholarly journals Surgery is an option in evolving myocardial infarction induced by spontaneous coronary artery dissection: a case report

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Ghaitha Al Mahruqi ◽  
Hilal Alsabti ◽  
Mirdavron Mukaddirov
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Angiogram ◽  
Coronary Artery Dissection ◽  
Severe Chest Pain ◽  
Left Circumflex Artery ◽  
Coronary Syndrome

Abstract Background Spontaneous coronary artery dissection (SCAD) has emerged as one of the important yet rare causes of acute coronary syndrome that primarily affect young peripartum women without cardiovascular risk factors. Despite the recent improvements in diagnosis and recognition of the importance of SCAD, it remains poorly studied and there has been no consensus of opinion regarding its optimal management. Case summary A 29-year-old breastfeeding woman presented with 1-day history of severe chest pain radiating to the jaw and both shoulders. Cardiovascular examination, 12 leads electrocardiogram, and echocardiography were normal. Troponin levels were elevated; hence, coronary angiogram was done and showed type 2 SCAD of the left anterior descending artery (LAD). The patient was managed conservatively. The next day, she started again to complain of severe chest pain and her troponin levels continued to rise. Repeated coronary angiogram revealed progression of the previous LAD dissection. Another dissection was also noticed in the left circumflex artery. Chest pain recurred over the night and her troponin levels continued to rise. An emergency coronary artery bypass grafting (CABG) was performed. The patient was doing well postoperatively and was discharged home on Day 8. Discussion Our patient presented with acute ischaemic changes secondary to SCAD. The report illustrates the risk factors, pathogenesis, diagnostic work up, and the possible therapeutic options of SCAD, which include conservative management and CABG. The management varies depending on the clinical presentation and the extent of the coronary artery dissection.

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 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

A RARE CASE OF TRIPLE VESSEL SPONTANEOUS CORONARY ARTERY DISSECTION

2020 ◽  
Vol 75 (11) ◽  
pp. 2393
Author(s):  
Raghuram Chava ◽  
Enrique Soltero Mariscal ◽  
Sunil Vasireddi ◽  
Ashish Aneja ◽  
Sanjay Gandhi
Keyword(s):  
Coronary Artery ◽  
Rare Case ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection

scholarly journals Spontaneous coronary artery dissection as a cause of ST-segment elevation myocardial infarction

2021 ◽  
Vol 29 ◽  
pp. 1-5
Author(s):  
Stéphany Bastos ◽  
Raquel Carbelin ◽  
José Francisco ◽  
Gustavo Matos ◽  
Evandro Matos Júnior ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Interventional Treatment ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Artery Disease

Spontaneous coronary artery dissection is an uncommon condition, and the patients’ clinical presentation is often underestimated due to few risk factors for atherosclerotic disease. Treatment must be individualized, with conservative therapy as the first option, respecting the criteria for referral for interventional treatment. We report a case of spontaneous coronary dissection, initially manifested as a non-ST segment elevation acute coronary syndrome, progressing to transmural infarction, in a young patient, with few risk factors for coronary artery disease, and give examples of difficulties related to the percutaneous approach.

scholarly journals Physical Activity and Exercise Patterns After Spontaneous Coronary Artery Dissection: Insights From a Large Multinational Registry

2021 ◽  
Vol 8 ◽  
Author(s):  
Audry S. Chacin-Suarez ◽  
Amanda R. Bonikowske ◽  
Jose R. Medina-Inojosa ◽  
Rajiv Gulati ◽  
Patricia J. Best ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Coronary Artery ◽  
Aerobic Exercise ◽  
Electronic Record ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Individual Assessment ◽  
Record Review

Objective: The objective of the study was to assess the physical activity (PA) and exercise patterns among participants in a large multinational spontaneous coronary artery dissection (SCAD) registry. Patients and Methods: Participants with SCAD enrolled from March 2011 to November 2019 completed surveys including details regarding PA and exercise habits prior to SCAD, and PA counseling received from their provider after SCAD. Demographics and clinical characteristics were collected by electronic record review. Exercise prescribed to patients after SCAD was categorized according to exercise components: type, intensity, frequency, time/session, and extreme environmental conditions.Results: We included 950 participants; mean ± age was 46.8 ± 9.5 years old at the time of first SCAD; most (96.3%) were women and (77.0%) attended ≥1 cardiac rehabilitation session. Hyperlipidemia (34.3%), hypertension (32.8%), and elevated body weight (overweight = 27.0%; obesity = 20.0%) were the most common comorbidities. Prior to SCAD, 48.5% performed aerobic exercise ≥3 times/week, and only 32.0% performed strength-building exercise regularly. PA counseling details after SCAD in 299/950 participants showed that most (93.3%) patients received some form of counseling including exercise prescription (EXP), non-specific recommendations, and discouraged from any exercise. Limits regarding exercise type and intensity were the most common advice among participants who received EXP.Conclusion: Insights from our study suggest that only 48% of the patients performed some aerobic exercise three or more times per week, and 32.0% performed strength-building exercises, which suggest that most of them may not be as active as assumed. Furthermore, 70% of the SCAD patients have ≥1 cardiovascular risk factors. We suggest guiding patients based on individual assessment, taking into consideration baseline PA habits, treatment, and risk factors. SCAD-tailored PA guidelines are needed for optimal EXP without compromising patient safety.

P1694Novel risk factors in spontaneous coronary artery dissection: thyroid disorders

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
S J Camacho Freire ◽  
M Garcia Guimaraes ◽  
L Gheorghe ◽  
T Bastante ◽  
A E Gomez Menchero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Thyroid Disorders ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection

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.

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