Spontaneous coronary artery dissection history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
The hallmark symptom of spontaneous coronary artery dissection (SCAD) is [[angina pectoris]], similar to to other [[acute coronary syndromes]], that 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. | The hallmark symptom of spontaneous coronary artery dissection (SCAD) is [[angina pectoris]], similar to to other [[acute coronary syndromes]], that 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. | ||
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Patients presenting with typical symptoms of [[acute coronary syndromes]] and the following clinical characteristics may have suspected spontaneous coronary artery dissection (SCAD): | 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> | *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]] | ||
*[[Atherosclerosis]] | *[[Atherosclerosis]] | ||
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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 idopathic.<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> | Many patients do not have a previous history of [[cardiovascular disease]] or other risk factors and SCAD is idopathic.<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== | ||
| Line 28: | Line 28: | ||
* [[chronic stable angina]] | * [[chronic stable angina]] | ||
* [[myocardial infarction]] | * [[myocardial infarction]] | ||
** 25% to 50% of cases are [[ST elevation myocardial infarction|STEMI]]<ref name="pmid25294399" | ** 25% to 50% of cases are [[ST elevation myocardial infarction|STEMI]]<ref name="pmid25294399" /> | ||
* [[cardiogenic shock]] | * [[cardiogenic shock]] | ||
* [[sudden death]] | * [[sudden death]] | ||
** 50% of sudden death cases were reported to have 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> | ** 50% of sudden death cases were reported to have 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]] | * [[pericardial tamponade]] | ||
Patients are typically asymptomatic on follow up.<ref name="pmid8673763" /> | Patients are typically asymptomatic on follow up.<ref name="pmid8673763" /> | ||
Revision as of 19:39, 1 December 2017
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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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Treatment |
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Case Studies |
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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.
Synonyms and keywords: SCAD
Overview
The hallmark symptom of spontaneous coronary artery dissection (SCAD) is angina pectoris, similar to to other acute coronary syndromes, that 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 and SCAD is idopathic.[3]
Symptoms
The symptoms of SCAD mimic other acute coronary syndromes.
- The most common symptom is an acute and severe onset of chest pain that may radiate to jaw and left arm.
Patients may present with:[8]
- chronic stable angina
- myocardial infarction
- cardiogenic shock
- sudden death
- 50% of sudden death cases were reported to have dissections in the left main coronary artery.[9]
- pericardial tamponade
Patients are typically asymptomatic on follow up.[8]
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 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.