COVID-19-associated spontaneous coronary artery dissection: Difference between revisions
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===Surgery=== | ===Surgery=== | ||
====Coronary Artery Bypass Graft (CABG)==== |
Revision as of 17:33, 1 July 2020
For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayesha Javid, MBBS[2]
Overview
Spontaneous coronary artery dissection (SCAD) is a non-iatrogenic non-traumatic separation of the coronary arterial wall. It could be either atherosclerotic or non-atherosclerotic.
Pathophysiology
- SCAD could be secondary to an atherosclerotic (A-SCAD) or non-atherosclerotic (NA-SCAD) lesion.
- In COVID-19 patients due to high inflammatory load, a localized inflammation of the coronary adventitia and periadventitial fat can occur. This could lead to the development of sudden coronary artery dissection in a susceptible patient with underlying cardiovascular disease.
Signs and symptoms
SCAD can present as acute coronary syndrome and NSTEMI. The signs and symptoms include;
- Sudden onset of retrosternal pain chest pain which remains persistent in a COVID-19 seropositive patient or in a patient with recent cough and dyspnea raises suspicion of SCAD.
- The chest pain can radiate to the left arm.
- It can be associated with;
- Dyspnea
- Syncope
- Nausea and vomiting.
Diagnosis
Laboratory tests
- Elevated serum troponin level.
- Increased high-sensitivity cardiac troponin T-test (hs-cTnT).
- Increased D-dimer.
- Blood count is usually in the normal range.
- Inflammatory markers are usually in the normal range.
ECG
- new ST-T abnormalities in the precordial leads which are not present earlier.
- inverted T waves in the inferior leads.
Coronary angiography
- Invasive coronary angiography is the "gold standard" used for the diagnosis of SCAD.
Echocardiogram
- Left ventricular dysfunction with decreased ejection fraction is seen.
- Akinesia or hypokinesia is seen in the affected territory of the heart.
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT)
- These imaging modalities show detailed morphology about the intramural lesion in situations when angiographic images are not clear. IVUS is important in followup of the treatment of SCAD patients.
Optical coherence tomography (OCT)
Treatment
Medical management
- Aspirin:
- Statins:
- Beta-blockers: Beta-blocker is associated with decreased recurrence of SCAD.[1]
Percutaneous coronary artery intervention (PCI)
Surgery
Coronary Artery Bypass Graft (CABG)
- ↑ Saw J, Humphries K, Aymong E, Sedlak T, Prakash R, Starovoytov A; et al. (2017). "Spontaneous Coronary Artery Dissection: Clinical Outcomes and Risk of Recurrence". J Am Coll Cardiol. 70 (9): 1148–1158. doi:10.1016/j.jacc.2017.06.053. PMID 28838364 PMID 28838364 Check
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