Spontaneous coronary artery dissection risk factors: Difference between revisions

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__NOTOC__
__NOTOC__
{{Spontaneous coronary artery dissection}}
{{Spontaneous coronary artery dissection}}
{{CMG}}; {{AE}}{{NRM}} {{AKK}}
{{CMG}}; {{AE}} {{Sara.Zand}} {{NRM}} {{AKK}}


{{SK}} SCAD
{{SK}} SCAD
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==Overview==
==Overview==


The risk factors for spontaneous coronary artery dissection include predisposing factors (e.g., [[vasculopathy]], [[pregnancy]], [[connective tissue disorder]], [[systemic inflammation]]) and precipitating stressors (e.g., [[exercise|strenuous exercise]], [[emotional stress]], [[recreational drugs]]).
The [[risk factors]] for [[spontaneous coronary artery dissection]] include predisposing factors ( [[vasculopathy]], [[pregnancy]], [[connective tissue disorder]], [[systemic inflammation]]) and precipitating stressors (e.g., [[exercise|strenuous exercise]], [[emotional stress]], [[recreational drugs]]).Features that raise the index of suspicion for [[SCAD]] include [[myocardial infarction]] in young women (age ≤50), absence of traditional [[Cardiovascular disease#Risk factors|cardiovascular risk factors]], little or no evidence of [[coronary atherosclerosis]], [[peripartum|peripartum state]], history of [[fibromuscular dysplasia]], history of [[connective tissue disorder]] or [[systemic inflammation]].


==Risk Factors==
==Risk Factors==


The phenotypic manifestation of spontaneous coronary artery dissection (SCAD) may occur as a result of predisposing factors compounded by precipitating stressors.<ref name="SawMancini2016">{{cite journal|last1=Saw|first1=Jacqueline|last2=Mancini|first2=G.B. John|last3=Humphries|first3=Karin H.|title=Contemporary Review on Spontaneous Coronary Artery Dissection|journal=Journal of the American College of Cardiology|volume=68|issue=3|year=2016|pages=297–312|issn=07351097|doi=10.1016/j.jacc.2016.05.034}}</ref> The presence of either predisposing or precipitating factors increases the risk of developing a dissection. The potential risk factors for SCAD include:<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>
*The phenotypic manifestation of [[spontaneous coronary artery dissection]] ([[SCAD]]) may occur as a result of predisposing factors compounded by precipitating [[stressors]].<ref name="SawMancini2016">{{cite journal|last1=Saw|first1=Jacqueline|last2=Mancini|first2=G.B. John|last3=Humphries|first3=Karin H.|title=Contemporary Review on Spontaneous Coronary Artery Dissection|journal=Journal of the American College of Cardiology|volume=68|issue=3|year=2016|pages=297–312|issn=07351097|doi=10.1016/j.jacc.2016.05.034}}</ref>  
*The presence of either predisposing or precipitating factors increases the risk of developing a [[dissection]].  
* The potential risk factors for [[SCAD]] include:<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><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="HayesKim2018">{{cite journal|last1=Hayes|first1=Sharonne N.|last2=Kim|first2=Esther S.H.|last3=Saw|first3=Jacqueline|last4=Adlam|first4=David|last5=Arslanian-Engoren|first5=Cynthia|last6=Economy|first6=Katherine E.|last7=Ganesh|first7=Santhi K.|last8=Gulati|first8=Rajiv|last9=Lindsay|first9=Mark E.|last10=Mieres|first10=Jennifer H.|last11=Naderi|first11=Sahar|last12=Shah|first12=Svati|last13=Thaler|first13=David E.|last14=Tweet|first14=Marysia S.|last15=Wood|first15=Malissa J.|title=Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association|journal=Circulation|volume=137|issue=19|year=2018|issn=0009-7322|doi=10.1161/CIR.0000000000000564}}</ref>
 


{| class="wikitable" style="font-size: 85%;"
{| class="wikitable" style="font-size: 85%;"
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* '''[[Fibromuscular dysplasia]]'''
* '''[[Fibromuscular dysplasia]]'''
* '''[[Pregnancy|Pregnancy-related]]:''' [[antepartum]], [[postpartum|early post-partum]], [[postpartum|late post-partum]], [[postpartum|very late post-partum]]
* '''[[Pregnancy|Pregnancy-related]]:''' [[antepartum]], [[postpartum|early post-partum]], [[postpartum|late post-partum]], [[postpartum|very late post-partum]]
* '''[[Pregnancy|Recurrent pregnancies]]:''' [[Parity (medicine)|multiparity]] or [[multigravida]]
* '''[[Pregnancy|Recurrent pregnancies]]:''' [[Parity (medicine)|multiparity ≥ 4 births]], [[multigravida]]
* '''[[Connective tissue disorder]]:''' [[Marfan syndrome]], [[Loeys-Dietz syndrome]], [[Ehlers-Danlos syndrome|Ehlers-Danlos syndrome type 4]], [[neurofibromatosis type I]], [[cystic medial necrosis]], [[alpha-1 antitrypsin deficiency]], [[polycystic kidney disease]], [[lysyl oxidase|lysyl oxidase deficiency]], [[Alport syndrome]], [[pseudoxanthoma elasticum]]
* '''[[Connective tissue disorder]]:''' [[Marfan syndrome]], [[Loeys-Dietz syndrome]], [[Ehlers-Danlos syndrome|Ehlers-Danlos syndrome type 4]], [[neurofibromatosis type I]], [[cystic medial necrosis]], [[alpha-1 antitrypsin deficiency]], [[polycystic kidney disease]], [[lysyl oxidase|lysyl oxidase deficiency]], [[Alport syndrome]], [[pseudoxanthoma elasticum]]
* [[Systemic inflammation|Systemic inflammatory disease]]: [[systemic lupus erythematosus]], [[Crohn's disease]], [[ulcerative colitis]], [[polyarteritis nodosa]], [[sarcoidosis]], [[Churg-Strauss syndrome]], [[Wegener's granulomatosis]], [[rheumatoid arthritis]], [[Kawasaki disease]], [[giant cell arteritis]], [[celiac disease]]
* '''[[Systemic inflammation|Systemic inflammatory disease]]:''' [[systemic lupus erythematosus]], [[Crohn's disease]], [[ulcerative colitis]], [[polyarteritis nodosa]], [[sarcoidosis]], [[Churg-Strauss syndrome]], [[Wegener's granulomatosis]], [[rheumatoid arthritis]], [[Kawasaki disease]], [[giant cell arteritis]], [[celiac disease]], [[Takayasu arteritis]], [[cryoglobulinemia]], [[Behçet's disease]]
* '''[[disease|Other disease]]:''' [[polycythemia vera]], [[hypothyroidism]]
* '''[[Hormonal therapy]]:''' [[oral contraceptive]], [[estrogen]], [[progesterone]], [[beta-HCG]], [[testosterone]], [[corticosteroids]], [[clomiphene]], [[polycystic ovarian syndrome]]
* '''[[Hormonal therapy]]:''' [[oral contraceptive]], [[estrogen]], [[progesterone]], [[beta-HCG]], [[testosterone]], [[corticosteroids]], [[clomiphene]], [[polycystic ovarian syndrome]]
* '''[[Takotsubo cardiomyopathy]]'''
* '''[[Takotsubo cardiomyopathy]]'''
* '''[[Coronary artery spasm]]'''
* '''[[Atherosclerosis]]'''
* '''[[Atherosclerosis]]'''
* '''[[Idiopathic]]'''
* '''[[Idiopathic]]'''
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| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Precipitating stressors'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Precipitating stressors'''
| style="background: #F5F5F5; padding: 5px;" colspan="2;"|
| style="background: #F5F5F5; padding: 5px;" colspan="2;"|
* [[exercise|Intense exercises]]: [[isometric exercise]], [[aerobic exercise]]
* '''[[exercise|Intense exercises]]:''' [[isometric exercise]], [[aerobic exercise]]
* [[emotional stress|Emotional stress]]
* ''' [[ emotional stress|Intense emotional stress]]'''
* [[Labor|Labor and delivery]]
* '''[[Labor|Labor and delivery]]'''
* [[Valsalva maneuver|Valsava-type activities]]: [[retching]], [[vomiting]], [[bowel movement]], [[coughing]]
* '''[[Valsalva maneuver|Valsava-type activities]]:''' [[retching]], [[vomiting]], [[bowel movement]], [[coughing]]
* [[Recreational drugs]]: [[cocaine]], [[amphetamines]], [[methamphetamines]]
* '''[[Recreational drugs]]:''' [[cocaine]], [[amphetamines]], [[methamphetamines]]
* [[Hormonal therapy]]: [[beta-HCG]], [[corticosteroids]]
* '''[[Hormonal therapy]]:''' [[beta-HCG]], [[corticosteroids]], [[clomiphen]]
* '''[[Drugs]]:''' [[Calcineurin|calcineurin inhibitors]], [[5-FU]], [[fenfluramine]], [[corticosteroids]], [[methylphenidate]], [[ergotamine]], [[sumatriptan]]
|}
|}
*After adjusting for cardiovascular risk factors, predisposing [[arteriopathies]], [[precipitating stressors]], [[medications]], and [[revascularization]], [[hypertension]] increased the risk of [[SCAD]] recurrence by 2.5 times, whereas [[beta-blocker]] usage reduced the recurrence risk by 64%.<ref name="SawHumphries2017">{{cite journal|last1=Saw|first1=Jacqueline|last2=Humphries|first2=Karin|last3=Aymong|first3=Eve|last4=Sedlak|first4=Tara|last5=Prakash|first5=Roshan|last6=Starovoytov|first6=Andrew|last7=Mancini|first7=G.B. John|title=Spontaneous Coronary Artery Dissection|journal=Journal of the American College of Cardiology|volume=70|issue=9|year=2017|pages=1148–1158|issn=07351097|doi=10.1016/j.jacc.2017.06.053}}</ref>


==References==
==References==

Latest revision as of 23:19, 5 May 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: Sara Zand, M.D.[2] Nate Michalak, B.A. Arzu Kalayci, M.D. [3]

Synonyms and keywords: SCAD

Overview

The risk factors for spontaneous coronary artery dissection include predisposing factors ( vasculopathy, pregnancy, connective tissue disorder, systemic inflammation) and precipitating stressors (e.g., strenuous exercise, emotional stress, recreational drugs).Features that raise the index of suspicion for SCAD include myocardial infarction in young women (age ≤50), absence of traditional cardiovascular risk factors, little or no evidence of coronary atherosclerosis, peripartum state, history of fibromuscular dysplasia, history of connective tissue disorder or systemic inflammation.

Risk Factors


Risk factor Condition
Predisposing factors
Precipitating stressors

References

  1. Saw, Jacqueline; Mancini, G.B. John; Humphries, Karin H. (2016). "Contemporary Review on Spontaneous Coronary Artery Dissection". Journal of the American College of Cardiology. 68 (3): 297–312. doi:10.1016/j.jacc.2016.05.034. ISSN 0735-1097.
  2. 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.
  3. 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.
  4. Hayes, Sharonne N.; Kim, Esther S.H.; Saw, Jacqueline; Adlam, David; Arslanian-Engoren, Cynthia; Economy, Katherine E.; Ganesh, Santhi K.; Gulati, Rajiv; Lindsay, Mark E.; Mieres, Jennifer H.; Naderi, Sahar; Shah, Svati; Thaler, David E.; Tweet, Marysia S.; Wood, Malissa J. (2018). "Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association". Circulation. 137 (19). doi:10.1161/CIR.0000000000000564. ISSN 0009-7322.
  5. Saw, Jacqueline; Humphries, Karin; Aymong, Eve; Sedlak, Tara; Prakash, Roshan; Starovoytov, Andrew; Mancini, G.B. John (2017). "Spontaneous Coronary Artery Dissection". Journal of the American College of Cardiology. 70 (9): 1148–1158. doi:10.1016/j.jacc.2017.06.053. ISSN 0735-1097.