Spontaneous coronary artery dissection history and symptoms: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Spontaneous coronary artery dissection}} | {{Spontaneous coronary artery dissection}} | ||
{{CMG}}; {{AE}}{{NRM}} | {{CMG}}; {{AE}}{{NRM}} {{AKK}} | ||
{{SK}} SCAD | {{SK}} SCAD | ||
==Overview== | ==Overview== | ||
The hallmark symptom of spontaneous coronary artery dissection (SCAD) is [[angina pectoris]], similar | The hallmark [[symptom]] of [[spontaneous coronary artery dissection]] ([[SCAD]]) is [[angina pectoris]], similar to other [[acute coronary syndromes]], which may radiate to the [[jaw]] or [[left arm]]. [[SCAD]] should be suspected with these [[symptoms]] in relatively [[young]] [[women]], especially those in [[Postpartum|postpartum status]]. However, many patients do not have [[typical]] [[risk factors]] of [[coronary artery disease]]. Patients are typically [[asymptomatic]] on follow-up. | ||
==History== | |||
Patients presenting with typical [[symptoms]] of [[acute coronary syndromes]] and the following clinical characteristics may have suspected [[spontaneous coronary artery dissection]] ([[SCAD]]): | |||
*[[Physical exertion]]<ref name="pmid7775001">{{cite journal| author=Azam MN, Roberts DH, Logan WF| title=Spontaneous coronary artery dissection associated with oral contraceptive use. | journal=Int J Cardiol | year= 1995 | volume= 48 | issue= 2 | pages= 195-8 | pmid=7775001 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7775001 }} </ref> | |||
*[[Emotional stress]]<ref name="SawRicci2013">{{cite journal|last1=Saw|first1=Jacqueline|last2=Ricci|first2=Donald|last3=Starovoytov|first3=Andrew|last4=Fox|first4=Rebecca|last5=Buller|first5=Christopher E.|title=Spontaneous Coronary Artery Dissection|journal=JACC: Cardiovascular Interventions|volume=6|issue=1|year=2013|pages=44–52|issn=19368798|doi=10.1016/j.jcin.2012.08.017}}</ref> | *[[Emotional stress]]<ref name="SawRicci2013">{{cite journal|last1=Saw|first1=Jacqueline|last2=Ricci|first2=Donald|last3=Starovoytov|first3=Andrew|last4=Fox|first4=Rebecca|last5=Buller|first5=Christopher E.|title=Spontaneous Coronary Artery Dissection|journal=JACC: Cardiovascular Interventions|volume=6|issue=1|year=2013|pages=44–52|issn=19368798|doi=10.1016/j.jcin.2012.08.017}}</ref> | ||
*Women with an average age ranging from 43 to 50 years<ref name="pmid25294399">{{cite journal| author=Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D et al.| title=Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 5 | pages= 645-55 | pmid=25294399 | doi=10.1161/CIRCINTERVENTIONS.114.001760 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25294399 }} </ref><ref name="pmid22800851">{{cite journal| author=Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ et al.| title=Clinical features, management, and prognosis of spontaneous coronary artery dissection. | journal=Circulation | year= 2012 | volume= 126 | issue= 5 | pages= 579-88 | pmid=22800851 | doi=10.1161/CIRCULATIONAHA.112.105718 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22800851 }} </ref> | *[[Women]] with an average age ranging from 43 to 50 years<ref name="pmid25294399">{{cite journal| author=Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D et al.| title=Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 5 | pages= 645-55 | pmid=25294399 | doi=10.1161/CIRCINTERVENTIONS.114.001760 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25294399 }} </ref><ref name="pmid22800851">{{cite journal| author=Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ et al.| title=Clinical features, management, and prognosis of spontaneous coronary artery dissection. | journal=Circulation | year= 2012 | volume= 126 | issue= 5 | pages= 579-88 | pmid=22800851 | doi=10.1161/CIRCULATIONAHA.112.105718 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22800851 }} </ref> | ||
*[[Postpartum]] status or history of [[pregnancy]]<ref name="VijayaraghavanVerma2014">{{cite journal|last1=Vijayaraghavan|first1=R.|last2=Verma|first2=S.|last3=Gupta|first3=N.|last4=Saw|first4=J.|title=Pregnancy-Related Spontaneous Coronary Artery Dissection|journal=Circulation|volume=130|issue=21|year=2014|pages=1915–1920|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.114.011422}}</ref> | *[[Postpartum]] status or history of [[pregnancy]]<ref name="VijayaraghavanVerma2014">{{cite journal|last1=Vijayaraghavan|first1=R.|last2=Verma|first2=S.|last3=Gupta|first3=N.|last4=Saw|first4=J.|title=Pregnancy-Related Spontaneous Coronary Artery Dissection|journal=Circulation|volume=130|issue=21|year=2014|pages=1915–1920|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.114.011422}}</ref> | ||
*History of [[smoking]] | *History of [[smoking]] | ||
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*Presence of a [[Connective tissue disorder]]: [[Marfan syndrome]], [[Loeys-Dietz syndrome]], [[Ehlers-Danlos syndrome|Ehlers-Danlos syndrome type 4]], [[cystic medial necrosis]], [[alpha-1 antitrypsin deficiency]], or [[polycystic kidney disease]]<ref name="SawAymong2014">{{cite journal|last1=Saw|first1=J.|last2=Aymong|first2=E.|last3=Sedlak|first3=T.|last4=Buller|first4=C. E.|last5=Starovoytov|first5=A.|last6=Ricci|first6=D.|last7=Robinson|first7=S.|last8=Vuurmans|first8=T.|last9=Gao|first9=M.|last10=Humphries|first10=K.|last11=Mancini|first11=G. B. J.|title=Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes|journal=Circulation: Cardiovascular Interventions|volume=7|issue=5|year=2014|pages=645–655|issn=1941-7640|doi=10.1161/CIRCINTERVENTIONS.114.001760}}</ref> | *Presence of a [[Connective tissue disorder]]: [[Marfan syndrome]], [[Loeys-Dietz syndrome]], [[Ehlers-Danlos syndrome|Ehlers-Danlos syndrome type 4]], [[cystic medial necrosis]], [[alpha-1 antitrypsin deficiency]], or [[polycystic kidney disease]]<ref name="SawAymong2014">{{cite journal|last1=Saw|first1=J.|last2=Aymong|first2=E.|last3=Sedlak|first3=T.|last4=Buller|first4=C. E.|last5=Starovoytov|first5=A.|last6=Ricci|first6=D.|last7=Robinson|first7=S.|last8=Vuurmans|first8=T.|last9=Gao|first9=M.|last10=Humphries|first10=K.|last11=Mancini|first11=G. B. J.|title=Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes|journal=Circulation: Cardiovascular Interventions|volume=7|issue=5|year=2014|pages=645–655|issn=1941-7640|doi=10.1161/CIRCINTERVENTIONS.114.001760}}</ref> | ||
Many patients do not have a previous history of [[cardiovascular disease]] or other risk factors and SCAD is | :*Many [[patients]] do not have a previous history of [[cardiovascular disease]] or other risk factors and[[ SCAD]] is [[idiopathic]].<ref name="pmid25294399">{{cite journal| author=Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D et al.| title=Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 5 | pages= 645-55 | pmid=25294399 | doi=10.1161/CIRCINTERVENTIONS.114.001760 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25294399 }} </ref> | ||
==Symptoms== | ==Symptoms== | ||
The symptoms of SCAD mimic other [[acute coronary syndromes]]. | *The [[symptoms]] of [[SCAD]] mimic other causes of [[acute coronary syndromes]]. | ||
* The most common symptom is an acute and severe onset of [[angina pectoris|chest pain]] | *The most common [[symptom]] is an acute and severe onset of [[angina pectoris|chest pain]] (reported in 85-96% of [[SCAD]] [[patients]]) characterized by:<ref name="KimLongo2020">{{cite journal|last1=Kim|first1=Esther S.H.|last2=Longo|first2=Dan L.|title=Spontaneous Coronary-Artery Dissection|journal=New England Journal of Medicine|volume=383|issue=24|year=2020|pages=2358–2370|issn=0028-4793|doi=10.1056/NEJMra2001524}}</ref> | ||
Patients may present with:<ref name="pmid8673763">{{cite journal| author=Zampieri P, Aggio S, Roncon L, Rinuncini M, Canova C, Zanazzi G et al.| title=Follow up after spontaneous coronary artery dissection: a report of five cases. | journal=Heart | year= 1996 | volume= 75 | issue= 2 | pages= 206-9 | pmid=8673763 | doi= | pmc=484263 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8673763 }} </ref> | <ref name="AdlamAlfonso2018">{{cite journal|last1=Adlam|first1=David|last2=Alfonso|first2=Fernando|last3=Maas|first3=Angela|last4=Vrints|first4=Christiaan|last5=al-Hussaini|first5=Abtehale|last6=Bueno|first6=Hector|last7=Capranzano|first7=Piera|last8=Gevaert|first8=Sofie|last9=Hoole|first9=Stephen P|last10=Johnson|first10=Tom|last11=Lettieri|first11=Corrado|last12=Maeder|first12=Micha T|last13=Motreff|first13=Pascal|last14=Ong|first14=Peter|last15=Persu|first15=Alexandre|last16=Rickli|first16=Hans|last17=Schiele|first17=Francois|last18=Sheppard|first18=Mary N|last19=Swahn|first19=Eva|title=European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection|journal=European Heart Journal|year=2018|issn=0195-668X|doi=10.1093/eurheartj/ehy080}}</ref><ref name="LuongStarovoytov2017">{{cite journal|last1=Luong|first1=Christina|last2=Starovoytov|first2=Andrew|last3=Heydari|first3=Milad|last4=Sedlak|first4=Tara|last5=Aymong|first5=Eve|last6=Saw|first6=Jacqueline|title=Clinical presentation of patients with spontaneous coronary artery dissection|journal=Catheterization and Cardiovascular Interventions|volume=89|issue=7|year=2017|pages=1149–1154|issn=15221946|doi=10.1002/ccd.26977}}</ref> | ||
* [[ | |||
* [[ | :*Radiation to the [[arm]] (49.5%) and [[neck]] (22.1%) | ||
* | :*Associated with [[nausea]] and [[vomiting]] (23.4%), [[diaphoresis]] (20.9%), [[dyspnea]] (19.3%), or [[back pain]] (12.2%) | ||
* [[ | :*Atypical features such as ‘[[pleuritic]]’ (9%),‘[[tearing]]’ (1.0%), and ‘[[positional]]’ (1%) | ||
* [[sudden death]] | |||
* | *One-fourth of [[patients]] have reported recurrent [[symptoms]] before seeking [[medical care]].<ref name="KimLongo2020">{{cite journal|last1=Kim|first1=Esther S.H.|last2=Longo|first2=Dan L.|title=Spontaneous Coronary-Artery Dissection|journal=New England Journal of Medicine|volume=383|issue=24|year=2020|pages=2358–2370|issn=0028-4793|doi=10.1056/NEJMra2001524}}</ref> | ||
* [[ | *[[Patients]] may present with:<ref name="pmid8673763">{{cite journal| author=Zampieri P, Aggio S, Roncon L, Rinuncini M, Canova C, Zanazzi G et al.| title=Follow up after spontaneous coronary artery dissection: a report of five cases. | journal=Heart | year= 1996 | volume= 75 | issue= 2 | pages= 206-9 | pmid=8673763 | doi= | pmc=484263 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8673763 }} </ref> | ||
Patients are typically asymptomatic on follow up.<ref name="pmid8673763" /> | |||
:* [[Chronic stable angina]] | |||
:* [[Myocardial infarction]]<ref name="pmid25294399" /> | |||
:* [[ST elevation myocardial infarction|STEMI]] (26% to 87%) | |||
:* [[Non ST elevation myocardial infarction|NSTEMI]] (13% to 69%) | |||
:* [[Cardiogenic shock]] (2% to 5%) | |||
:* [[Ventricular arrhythmia]] or [[sudden cardiac death]] (3% to 11%) | |||
:* [[Sudden cardiac death]] due to [[dissections]] in the [[left main coronary artery]].<ref name="pmid8665336">{{cite journal| author=Basso C, Morgagni GL, Thiene G| title=Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death. | journal=Heart | year= 1996 | volume= 75 | issue= 5 | pages= 451-4 | pmid=8665336 | doi= | pmc=484340 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8665336 }} </ref> | |||
:*[[Pericardial tamponade]] | |||
*[[Patients]] are typically [[asymptomatic]] on follow up.<ref name="pmid8673763" /> | |||
==References== | ==References== | ||
Latest revision as of 16:40, 7 March 2021
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Spontaneous Coronary Artery Dissection Microchapters |
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Differentiating Spontaneous coronary artery dissection from other Diseases |
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Diagnosis |
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Type 1 Type 2A Type 2B Type 3 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A. Arzu Kalayci, M.D. [2]
Synonyms and keywords: SCAD
Overview
The hallmark symptom of spontaneous coronary artery dissection (SCAD) is angina pectoris, similar to other acute coronary syndromes, which may radiate to the jaw or left arm. SCAD should be suspected with these symptoms in relatively young women, especially those in postpartum status. However, many patients do not have typical risk factors of coronary artery disease. Patients are typically asymptomatic on follow-up.
History
Patients presenting with typical symptoms of acute coronary syndromes and the following clinical characteristics may have suspected spontaneous coronary artery dissection (SCAD):
- Physical exertion[1]
- Emotional stress[2]
- Women with an average age ranging from 43 to 50 years[3][4]
- Postpartum status or history of pregnancy[5]
- History of smoking
- Atherosclerosis
- Cocaine abuse[6]
- Presence of a Connective tissue disorder: Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome type 4, cystic medial necrosis, alpha-1 antitrypsin deficiency, or polycystic kidney disease[7]
- Many patients do not have a previous history of cardiovascular disease or other risk factors andSCAD is idiopathic.[3]
Symptoms
- The symptoms of SCAD mimic other causes of acute coronary syndromes.
- The most common symptom is an acute and severe onset of chest pain (reported in 85-96% of SCAD patients) characterized by:[8]
- Radiation to the arm (49.5%) and neck (22.1%)
- Associated with nausea and vomiting (23.4%), diaphoresis (20.9%), dyspnea (19.3%), or back pain (12.2%)
- Atypical features such as ‘pleuritic’ (9%),‘tearing’ (1.0%), and ‘positional’ (1%)
- One-fourth of patients have reported recurrent symptoms before seeking medical care.[8]
- Patients may present with:[11]
- Chronic stable angina
- Myocardial infarction[3]
- STEMI (26% to 87%)
- NSTEMI (13% to 69%)
- Cardiogenic shock (2% to 5%)
- Ventricular arrhythmia or sudden cardiac death (3% to 11%)
- Sudden cardiac death due to dissections in the left main coronary artery.[12]
- Pericardial tamponade
- Patients are typically asymptomatic on follow up.[11]
References
- ↑ Azam MN, Roberts DH, Logan WF (1995). "Spontaneous coronary artery dissection associated with oral contraceptive use". Int J Cardiol. 48 (2): 195–8. PMID 7775001.
- ↑ Saw, Jacqueline; Ricci, Donald; Starovoytov, Andrew; Fox, Rebecca; Buller, Christopher E. (2013). "Spontaneous Coronary Artery Dissection". JACC: Cardiovascular Interventions. 6 (1): 44–52. doi:10.1016/j.jcin.2012.08.017. ISSN 1936-8798.
- ↑ 3.0 3.1 3.2 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.
- ↑ Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ; et al. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851.
- ↑ Vijayaraghavan, R.; Verma, S.; Gupta, N.; Saw, J. (2014). "Pregnancy-Related Spontaneous Coronary Artery Dissection". Circulation. 130 (21): 1915–1920. doi:10.1161/CIRCULATIONAHA.114.011422. ISSN 0009-7322.
- ↑ Jaffe, Brian D.; Broderick, Thomas M.; Leier, Carl V. (1994). "Cocaine-Induced Coronary-Artery Dissection". New England Journal of Medicine. 330 (7): 510–511. doi:10.1056/NEJM199402173300719. ISSN 0028-4793.
- ↑ Saw, J.; Aymong, E.; Sedlak, T.; Buller, C. E.; Starovoytov, A.; Ricci, D.; Robinson, S.; Vuurmans, T.; Gao, M.; Humphries, K.; Mancini, G. B. J. (2014). "Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes". Circulation: Cardiovascular Interventions. 7 (5): 645–655. doi:10.1161/CIRCINTERVENTIONS.114.001760. ISSN 1941-7640.
- ↑ 8.0 8.1 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.
- ↑ Adlam, David; Alfonso, Fernando; Maas, Angela; Vrints, Christiaan; al-Hussaini, Abtehale; Bueno, Hector; Capranzano, Piera; Gevaert, Sofie; Hoole, Stephen P; Johnson, Tom; Lettieri, Corrado; Maeder, Micha T; Motreff, Pascal; Ong, Peter; Persu, Alexandre; Rickli, Hans; Schiele, Francois; Sheppard, Mary N; Swahn, Eva (2018). "European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection". European Heart Journal. doi:10.1093/eurheartj/ehy080. ISSN 0195-668X.
- ↑ Luong, Christina; Starovoytov, Andrew; Heydari, Milad; Sedlak, Tara; Aymong, Eve; Saw, Jacqueline (2017). "Clinical presentation of patients with spontaneous coronary artery dissection". Catheterization and Cardiovascular Interventions. 89 (7): 1149–1154. doi:10.1002/ccd.26977. ISSN 1522-1946.
- ↑ 11.0 11.1 Zampieri P, Aggio S, Roncon L, Rinuncini M, Canova C, Zanazzi G; et al. (1996). "Follow up after spontaneous coronary artery dissection: a report of five cases". Heart. 75 (2): 206–9. PMC 484263. PMID 8673763.
- ↑ 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.