Spontaneous coronary artery dissection pathophysiology: Difference between revisions

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==Overview==
==Overview==


At present, the [[pathophysiology]] of [[non-atherosclerotic]] [[spontaneous coronary artery dissection]] (NA-[[SCAD]]) continues to be poorly understood due to the rarity of this condition and its heterogeneous [[pathology]]. Although [[intimal tear]] or [[bleeding]] of [[vasa vasorum]] with intermedial [[hemorrhage]] seems to be the most probable reason, the exact underlying mechanism is still unknown.
At present, the [[pathophysiology]] of [[non-atherosclerotic]] [[spontaneous coronary artery dissection]] (NA-[[SCAD]]) continues to be poorly understood due to the rarity of this condition and its heterogeneous [[pathology]]. Although [[intimal tear]] or [[bleeding]] of [[vasa vasorum]] with intermedial [[hemorrhage]] seems to be the most probable reason, the exact underlying mechanism is still unknown. In a [[SCAD]] registry, a total of 5% to 8% of [[patients]] were carriers of [[genetic]] [[mutations]] for [[connective tissue disorders]]. [[SCAD]] may also be associated with a variety of disorders including but not limited to [[fibromuscular dysplasia]], [[Connective tissue disorders]], and [[autoimmune diseases]] such as [[systemic lupus erythematous]].  


==Pathophysiology==
==Pathophysiology==
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==Associated Conditions==
==Associated Conditions==
[[Conditions]] associated with SCAD include:
[[Conditions]] associated with SCAD include:
*[[Connective tissue disorders]] such as: <ref name="HenkinNegrotto2016">{{cite journal|last1=Henkin|first1=Stanislav|last2=Negrotto|first2=Sara M|last3=Tweet|first3=Marysia S|last4=Kirmani|first4=Salman|last5=Deyle|first5=David R|last6=Gulati|first6=Rajiv|last7=Olson|first7=Timothy M|last8=Hayes|first8=Sharonne N|title=Spontaneous coronary artery dissection and its association with heritable connective tissue disorders|journal=Heart|volume=102|issue=11|year=2016|pages=876–881|issn=1355-6037|doi=10.1136/heartjnl-2015-308645}}</ref>
*[[Connective tissue disorders]] such as: <ref name="HenkinNegrotto2016">{{cite journal|last1=Henkin|first1=Stanislav|last2=Negrotto|first2=Sara M|last3=Tweet|first3=Marysia S|last4=Kirmani|first4=Salman|last5=Deyle|first5=David R|last6=Gulati|first6=Rajiv|last7=Olson|first7=Timothy M|last8=Hayes|first8=Sharonne N|title=Spontaneous coronary artery dissection and its association with heritable connective tissue disorders|journal=Heart|volume=102|issue=11|year=2016|pages=876–881|issn=1355-6037|doi=10.1136/heartjnl-2015-308645}}</ref>
**[[Vascular]] [[Ehlers–Danlos syndrome]]
**[[Vascular]] [[Ehlers–Danlos syndrome]]
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[[Category:Angiographic Definitions]]
[[Category:Angiographic Definitions]]
[[Category:Disease]]
[[Category:Disease]]
[[Category: Needs English Review]]

Revision as of 19:16, 10 April 2021

Spontaneous Coronary Artery Dissection Microchapters

Home

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Spontaneous coronary artery dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Angiography

CT

MRI

Echocardiography

Other Imaging Findings

Other Diagnostic Studies

Treatment

Treatment Approach

Medical Therapy

Percutaneous Coronary Intervention

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Type 1

Type 2A

Type 2B

Type 3

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2]; Nate Michalak, B.A.

Synonyms and keywords: SCAD

Overview

At present, the pathophysiology of non-atherosclerotic spontaneous coronary artery dissection (NA-SCAD) continues to be poorly understood due to the rarity of this condition and its heterogeneous pathology. Although intimal tear or bleeding of vasa vasorum with intermedial hemorrhage seems to be the most probable reason, the exact underlying mechanism is still unknown. In a SCAD registry, a total of 5% to 8% of patients were carriers of genetic mutations for connective tissue disorders. SCAD may also be associated with a variety of disorders including but not limited to fibromuscular dysplasia, Connective tissue disorders, and autoimmune diseases such as systemic lupus erythematous.

Pathophysiology

Two possible mechanisms have been described for the arterial wall separation: [3]

Hematoxylin and trichrome stain of the coronary artery demonstrating an intramural hematoma compressing the vessel lumen from outside.
(Adapted from Br J Sports Med. 2012; 46(Suppl_1): i15–i21. under CC BY-NC license) [14]

Genetics

Associated Conditions

Conditions associated with SCAD include:

References

  1. Alfonso F (2012). "Spontaneous coronary artery dissection: new insights from the tip of the iceberg?". Circulation. 126 (6): 667–70. doi:10.1161/CIRCULATIONAHA.112.122093. PMID 22800852.
  2. Choi JW, Davidson CJ (2002). "Spontaneous multivessel coronary artery dissection in a long-distance runner successfully treated with oral antiplatelet therapy". The Journal of Invasive Cardiology. 14 (11): 675–8. PMID 12403896.
  3. 3.0 3.1 Saw J, Mancini GBJ, Humphries KH (2016). "Contemporary Review on Spontaneous Coronary Artery Dissection". J Am Coll Cardiol. 68 (3): 297–312. doi:10.1016/j.jacc.2016.05.034. PMID 27417009.
  4. Alfonso F, Bastante T (2014). "Spontaneous coronary artery dissection: novel diagnostic insights from large series of patients". Circ Cardiovasc Interv. 7 (5): 638–41. doi:10.1161/CIRCINTERVENTIONS.114.001984. PMID 25336602.
  5. Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D; et al. (2014). "Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes". Circ Cardiovasc Interv. 7 (5): 645–55. doi:10.1161/CIRCINTERVENTIONS.114.001760. PMID 25294399.
  6. Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS; et al. (2014). "Spontaneous coronary artery dissection: revascularization versus conservative therapy". Circ Cardiovasc Interv. 7 (6): 777–86. doi:10.1161/CIRCINTERVENTIONS.114.001659. PMID 25406203.
  7. 7.0 7.1 Saw J, Mancini GB, Humphries K, Fung A, Boone R, Starovoytov A; et al. (2016). "Angiographic appearance of spontaneous coronary artery dissection with intramural hematoma proven on intracoronary imaging". Catheter Cardiovasc Interv. 87 (2): E54–61. doi:10.1002/ccd.26022. PMID 26198289.
  8. 8.0 8.1 8.2 Alfonso F, Paulo M, Gonzalo N, Dutary J, Jimenez-Quevedo P, Lennie V; et al. (2012). "Diagnosis of spontaneous coronary artery dissection by optical coherence tomography". J Am Coll Cardiol. 59 (12): 1073–9. doi:10.1016/j.jacc.2011.08.082. PMID 22421300.
  9. Isner JM, Donaldson RF, Fortin AH, Tischler A, Clarke RH (1986). "Attenuation of the media of coronary arteries in advanced atherosclerosis". Am J Cardiol. 58 (10): 937–9. PMID 3776849.
  10. Basso C, Morgagni GL, Thiene G (1996). "Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death". Heart. 75 (5): 451–4. PMC 484340. PMID 8665336.
  11. Vijayaraghavan R, Verma S, Gupta N, Saw J (2014). "Pregnancy-related spontaneous coronary artery dissection". Circulation. 130 (21): 1915–20. doi:10.1161/CIRCULATIONAHA.114.011422. PMID 25403597.
  12. Eleid MF, Guddeti RR, Tweet MS, Lerman A, Singh M, Best PJ; et al. (2014). "Coronary artery tortuosity in spontaneous coronary artery dissection: angiographic characteristics and clinical implications". Circ Cardiovasc Interv. 7 (5): 656–62. doi:10.1161/CIRCINTERVENTIONS.114.001676. PMID 25138034.
  13. Saw J, Bezerra H, Gornik HL, Machan L, Mancini GB (2016). "Angiographic and Intracoronary Manifestations of Coronary Fibromuscular Dysplasia". Circulation. 133 (16): 1548–59. doi:10.1161/CIRCULATIONAHA.115.020282. PMID 26957531.
  14. Sheppard MN (2012). "Aetiology of sudden cardiac death in sport: a histopathologist's perspective". Br J Sports Med. 46 Suppl 1: i15–21. doi:10.1136/bjsports-2012-091415. PMC 3603681. PMID 23097474.
  15. 15.0 15.1 15.2 15.3 . doi:10.1161/circ.138.suppl_1.15404 and 28570239 Check |doi= value (help). Missing or empty |title= (help)
  16. Litwok, Yonathan; Lau, Joe; Soni, Mihir (2019). "THE ASSOCIATION OF CONNECTIVE TISSUE DISEASE AND CORONARY VASCULATURE: A CASE REPORT OF SPONTANEOUS CORONARY ARTERY DISSECTION IN A YOUNG FEMALE". Journal of the American College of Cardiology. 73 (9): 2675. doi:10.1016/S0735-1097(19)33281-4. ISSN 0735-1097.
  17. 17.0 17.1 Klingenberg-Salachova F, Limburg S, Boereboom F (February 2012). "Spontaneous coronary artery dissection in polycystic kidney disease". Clin Kidney J. 5 (1): 44–6. doi:10.1093/ndtplus/sfr158. PMC 4400459. PMID 26069747.
  18. Basile C, Lucarelli K, Langialonga T (2009). "Spontaneous coronary artery dissection: One more extrarenal manifestation of autosomal dominant polycystic kidney disease?". J Nephrol. 22 (3): 414–6. PMID 19557720.
  19. Garcia-Bermúdez M, Moustafa AH, Barrós-Membrilla A, Tizón-Marcos H (February 2017). "Repeated Loss of Consciousness in a Young Woman: A Suspicious SMAD3 Mutation Underlying Spontaneous Coronary Artery Dissection". Can J Cardiol. 33 (2): 292.e1–292.e3. doi:10.1016/j.cjca.2016.09.004. PMID 27986426.
  20. Blinc A, Maver A, Rudolf G, Tasič J, Pretnar Oblak J, Berden P, Peterlin B (December 2015). "Clinical Exome Sequencing as a Novel Tool for Diagnosing Loeys-Dietz Syndrome Type 3". Eur J Vasc Endovasc Surg. 50 (6): 816–21. doi:10.1016/j.ejvs.2015.08.003. PMID 26409702.
  21. Henkin, Stanislav; Negrotto, Sara M; Tweet, Marysia S; Kirmani, Salman; Deyle, David R; Gulati, Rajiv; Olson, Timothy M; Hayes, Sharonne N (2016). "Spontaneous coronary artery dissection and its association with heritable connective tissue disorders". Heart. 102 (11): 876–881. doi:10.1136/heartjnl-2015-308645. ISSN 1355-6037.
  22. Faden, Majed S; Bottega, Natalie; Benjamin, Alice; Brown, Richard N (2016). "A nationwide evaluation of spontaneous coronary artery dissection in pregnancy and the puerperium". Heart. 102 (24): 1974–1979. doi:10.1136/heartjnl-2016-309403. ISSN 1355-6037.
  23. Lie, J.T.; Berg, K.K. (1987). "Isolated fibromuscular dysplasia of the coronary arteries with spontaneous dissection and myocardial infarction". Human Pathology. 18 (6): 654–656. doi:10.1016/S0046-8177(87)80368-4. ISSN 0046-8177.
  24. Kim, Esther S.H.; Longo, Dan L. (2020). "Spontaneous Coronary-Artery Dissection". New England Journal of Medicine. 383 (24): 2358–2370. doi:10.1056/NEJMra2001524. ISSN 0028-4793.
  25. Reddy, Sravan; Vaid, Tejasvini; Ganiga Sanjeeva, Naveen Chandra; Shetty, Ranjan K (2016). "Spontaneous coronary artery dissection as the first presentation of systemic lupus erythematosus". BMJ Case Reports: bcr2016216344. doi:10.1136/bcr-2016-216344. ISSN 1757-790X.
  26. Kanaroglou, Savas; Nair, Vidhya; Fernandes, John R (2015). "Sudden cardiac death due to coronary artery dissection as a complication of cardiac sarcoidosis". Cardiovascular Pathology. 24 (4): 244–246. doi:10.1016/j.carpath.2015.01.001. ISSN 1054-8807.
  27. Bayar, Nermin; Çağırcı, Göksel; Üreyen, Çağın Mustafa; Kuş, Görkem; Küçükseymen, Selçuk; Arslan, Şakir (2015). "The Relationship between Spontaneous Multi-Vessel Coronary Artery Dissection and Celiac Disease". Korean Circulation Journal. 45 (3): 242. doi:10.4070/kcj.2015.45.3.242. ISSN 1738-5520.