Spontaneous Coronary Artery Dissection in Multiple Gestation Peripartum Period

2021 ◽  
Vol 17 (2) ◽  
pp. 124-125
Author(s):  
Kootaybah Alsheikhly ◽  
Hiba Obeid ◽  
Jason Donaghue
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
African American Woman ◽  
Normal Sinus Rhythm ◽  
American Woman ◽  
Sudden Onset ◽  
Artery Dissection ◽  
Multiple Gestation ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection

Background: Non-atherosclerotic spontaneous coronary artery dissection (SCAD) is defined as a non-traumatic and non-iatrogenic separation of the coronary arterial wall. SCAD is a highly uncommon cause of myocardial infarction (0.1 to 0.4 %). Case presentation: 40-year-old African American woman, G1T1P0A0L2, with a past medical history of tobacco abuse and obesity who had uncomplicated cesarean section delivery for healthy twins two weeks prior presented with substernal, sudden onset chest pain. The pain radiated to left arm and back, pressure-like, and is associated with nausea, vomiting, and dyspnea. On examination she was within normal limits except for a well-healed C-section wound. An electrocardiogram showed normal sinus rhythm with Nonspecific ST Abnormality. The first set of troponins less than 0.03, the second set shows troponins 0.18 and D-dimer 2340. The chest x-ray was unremarkable. An echocardiogram showed only mild to moderate mitral valve regurgitation. CT angiography of the chest showed no evidence of pulmonary embolism. She was started on a heparin drip and catheterization the next day showed no atherosclerotic coronary artery disease, but SCAD of inferior diagonal first branch noted. No intervention was done, heparin was stopped. The patient was started on aspirin, statin, Clopidogrel, Metoprolol, and Lisinopril per cardiology recommendation. Conclusions: As an internist and primary care provider, we should keep Non-atherosclerotic SCAD in mind when a young female patient presents with acute chest pain. More studies are needed to find out the optimal management. Current recommended conservative medical management includes long-term aspirin, beta blocker, and one year of clopidogrel, with the addition of a statin in patients with dyslipidemia.

scholarly journals Spontaneous Coronary Artery Dissection as Presenting Feature of Vascular Ehlers-Danlos Syndrome

2021 ◽  
Vol 11 (3) ◽  
pp. 129-131
Author(s):  
J. Bos ◽  
E. Overwater ◽  
M.T. Dirksen ◽  
S. Simsek ◽  
S. Demirdas ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Chest Pain ◽  
Coronary Artery ◽  
Sudden Onset ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Ehlers Danlos Syndrome ◽  
Danlos Syndrome

A spontaneous coronary artery dissection as the sole presenting feature of vascular Ehlers-Danlos syndrome is an uncommon finding. We present a 33-year-old woman with sudden onset chest pain caused by a spontaneous coronary artery dissection. Genetic testing revealed vascular Ehlers-Danlos syndrome as the underlying cause. Specifically, we show the value of genetic testing, which in some patients may be the only way of establishing a diagnosis.

A rare cause of chest pain in paediatric age: a teenager with acute myocardial infarction due to spontaneous coronary artery dissection

2022 ◽  
Vol 15 (1) ◽  
pp. e246393
Author(s):  
Filipa Costa Cascais ◽  
Ana Rita Pereira ◽  
Ana Rita Almeida ◽  
Luísa Rocha
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Warning Signs ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Paediatric Age ◽  
Life Threatening

A healthy 17-year-old boy was admitted to the emergency department presenting with a pressure-like sternal pain that started during exercise. His physical examination was normal. Twelve-lead ECG and transthoracic echocardiogram suggested a myocardial infarction. The patient was submitted to an invasive coronary angiography, which revealed a distal occlusion of the left anterior descending artery, due to a spontaneous coronary artery dissection. A balloon angioplasty was performed, with good results. Aetiological study did not discover any pathologic condition. Chest pain in paediatric age is a frequent complaint, despite not being usually caused by a serious condition. However, it is important to remember warning signs in order to diagnose life-threatening diseases, as soon as possible.

scholarly journals Spontaneous Coronary Artery Dissection – A Case Report

2018 ◽  
Vol 12 (2) ◽  
pp. 105-107
Author(s):  
Samsun Nahar ◽  
Fatema Begum ◽  
Momenuzzaman ◽  
KN Khan
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Chest Pain ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
St Elevation ◽  
The Right ◽  
Spontaneous Dissection

Spontaneous coronary artery dissection is a rather rare cause of myocardial infarction, chest pain, and sudden death.There are currently no known direct causes of this condition.Most of the reported dissections have occurred in the left anterior descending coronary artery.Herein, we report the case of a 58-year-old woman who presented at our institution with an acute ST-elevation myocardial infarction secondary to a spontaneous dissection of the right coronary artery. Primary PCIresolved the occlusion of the artery, and the patient was discharged from the hospital on medical therapy.University Heart Journal Vol. 12, No. 2, July 2016; 105-107

Spontaneous coronary artery dissection in a postpartum woman presenting with chest pain

2010 ◽  
Vol 28 (5) ◽  
pp. 641.e5-641.e7 ◽  
Author(s):  
Leo Marcoff ◽  
Andra Popescu ◽  
Gilbert A. Leidig ◽  
Anthony W. Clay ◽  
John J. Kelly ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Postpartum Woman ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection

scholarly journals 499 What light through yonder window breaks? Benefits of optical coherence tomography (OCT) in a case of spontaneous coronary artery dissection

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alessandro Maino ◽  
Rocco Vergallo ◽  
Alfredo Ricchiuto ◽  
Marco Lombardi ◽  
Angela Buonpane ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Artery Dissection ◽  
Intravascular Imaging ◽  
Spontaneous Coronary Artery Dissection ◽  
Intramural Haematoma ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
St Segment ◽  
Cardiovascular Evaluation

Abstract Aims Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary arterial walls, creating a false lumen. SCAD is an infrequent and often missed diagnosis especially in women presenting with acute coronary syndrome and in the majority of cases angiography alone could be insufficient for identification. Methods and results A 43-year-old woman presented to the Emergency Department of Fondazione Policlinico Universitario A. Gemelli IRCCS (Rome, Italy) for oppressive acute chest pain radiated to the right jaw, resolved spontaneously within a few minutes. Physical examination, including cardiovascular evaluation, was normal. High-sensitivity troponin was 152 ng/l and 250 ng/l in two serial determination (reference range, 0.0–37 ng/l). EKG showed sinus rhythm with no significant ST-segment alterations. Echocardiography revealed preserved biventricular systolic function with mild hypokinesia of the apical segments of the left ventricle. A diagnosis of NSTEMI was made based on clinical and laboratory parameters. Thus, urgent coronary angiography was performed, which demonstrated a single vessel disease with an eccentric, and angiographically complex stenosis of the proximal left anterior descending (LAD) artery with an image of plus compatible with a plaque ulceration. In order to define the extension of the disease and ostium involvement for a better procedural planning, OCT imaging was performed. Surprisingly, OCT showed a intramural haematoma extending from the ADA ostium to the proximal tract (approximately 22 mm) with ulceration in the body, minimal lumen area (MLA) 2.0 mm2 and evidence of normal trilaminar structure of the vessel both on downstream and upstream of the lesion. The angiographic features were compatible with type 2A SCAD. The therapeutic management was conservative with continuation of the double antiplatelet therapy and remote CT monitoring. Three days later, because of a new onset of chest pain and slight elevation of the ST segment on EKG, was performed a coronarographic control: the angiographic appearance of the lesion was substantially unchanged; OCT showed unmodified longitudinal extension of the lesion (about 22 mm) and relative increase in the endoluminal caliber compared to the previous examination (MLA 4.0 mm2).After 2 weeks, coronary CTA control was carried out, which documented the stability of the intramural hematoma in the proximal LAD, extended for 22 mm and with a maximum thickness of 2 mm, determining lumen narrowing of 40–45% The patient was discharged on medical therapy and no events occurred during the follow-up. Six month later, repeat CTA showed a complete resorption of the intramural haematoma. Conclusions In this case we highlight the utility of intravascular imaging, in particular OCT, in the evaluation of angiographic lesions of non-univocal interpretation and how its use can change the management and prognosis of ACS patients. Furthermore, the spontaneous resolution of the clinical and anatomical scenario through conservative treatment additionally confirms spontaneous healing as the natural history of SCAD and foreground the role of precise diagnosis (and intravascular imaging showed to improve it) for therapy shift and calibration.

scholarly journals A tale of two SCADs: Spontaneous coronary artery dissection series

2021 ◽  
Vol 9 (37) ◽  
pp. 70-73
Author(s):  
Sanjana Rao ◽  
Nitish Mittal ◽  
Mohammad M Ansari
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Intramural Hematoma ◽  
Rare Condition ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Shortness Of Breath ◽  
Coronary Artery Dissection ◽  
Coronary Artery Angiography ◽  
Associated Symptoms

Spontaneous coronary artery dissection (SCAD), a relatively rare condition, occurs when a tear is present in the coronary artery walls, slowing the flow of blood due to potential clotting. Most patients show symptoms of chest pain or shortness of breath; however, SCAD is seen mostly in relatively young and healthy women with minimal past medical history. Within this report, we present two female SCAD patients and the etiology of a SCAD case, including a complicated diagnosis and treatment. We describe a 33-year-old woman and a 40-year-old woman both presenting to the emergency department with chest pain and shortness of breath. Electrocardiogram was done and coronary artery angiography was performed on both patients, demonstrating a SCAD. Both patients were treated with aspirin, bet-blockers, and statin to relieve associated symptoms and accordingly discharged.   Key words: Spontaneous coronary artery dissection (SCAD), Female, intramural hematoma

Abstract 105: Rehospitalization After Admission With Myocardial Infarction and Spontaneous Coronary Artery Dissection

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Ahmed Elkaryoni ◽  
Kevin F Kennedy ◽  
Anna Grodzinsky ◽  
Sahar Naderi ◽  
Malissa J Wood ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Chest Pain ◽  
Coronary Artery ◽  
Young Patients ◽  
Artery Dissection ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Patient Factors ◽  
Factors Associated

Introduction: Spontaneous coronary artery dissection (SCAD) is one of the most common non-atherosclerotic causes of myocardial infarction (MI) in young patients, yet little is known about post-discharge outcomes. Given the high psychological stress of a SCAD diagnosis, we sought to understand the rehospitalization burden after SCAD so as to provide more prognostic data to SCAD patients. Methods: Using data from the Nationwide Readmission Database 2010-16, we identified patients 18-55 years of age hospitalized with MI with and without SCAD. We compared readmission over 1 year after index hospitalization for all-cause, MI, chest pain without MI, and heart failure. Cox proportional regression was used to examine factors associated with readmission, and we explored interactions of patient factors*SCAD to identify factors associated with differential risk of readmission in patients with SCAD. Results: Among 327,227 young patients admitted with an MI, 3704 (1.1%) had a diagnosis of SCAD. Patients with SCAD were more likely to be younger, women, have a higher burden of anxiety or depression, and longer length of stay compared with those without SCAD. While the risk of all-cause rehospitalization over 1 year was similar in those with versus without SCAD (KM-estimated rates: 22.3% vs. 24.1%; log-rank p=0.596, Figure), patients with SCAD were more likely to be rehospitalized for MI (4.9% vs. 4.2%, log-rank p=0.012) and chest pain without MI (3.6% vs. 2.8%, log-rank p=0.060) but less likely to be rehospitalized for heart failure (1.0 % vs. 1.8%, log-rank p=0.005). In the multivariable model, a diagnosis of SCAD was not associated with risk of rehospitalization (HR 1.00, 95% CI 0.92-1.08) nor was a diagnosis of SCAD associated with a differential effect of any of the patient factors on the risk of rehospitalization (all interaction p-values >0.05). Conclusion: Although patients with SCAD had a similar risk of rehospitalization compared with young patients with MI but without SCAD, we identified different patterns of hospitalization, which may be explained by the different underlying conditions. Further studies are needed to investigate possible interventions to reduce the high burden of post-SCAD rehospitalizations.

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