Causation or coincidence? A case of sudden death due to spontaneous coronary artery dissection in presence of myocardial bridging

Arslan

American Journal of Forensic Medicine &Amp; Pathology

et al. 2015

The number of cases with spontaneous coronary artery dissection (SCAD) is considered to be being underestimated because of a large amount of SCAD leading to sudden death without previous diagnosis. Besides, not only in clinics but also in autopsy practice, correct diagnosis of SCAD is important to prevent forensic malpractice.The article is intended to discuss the pathological findings through the forensic point of view for improving the malpractice expertise in scope of clinicians' timely antemortem diagnosis according to risk factors and in scope of forensic pathologists' the cause of death determination ability according to macroscopical and microscopical findings of the autopsy.In 3 cases reported, the main characteristics were the female sex, pregnancy history and a sudden death without any trauma. However, although there are many women giving birth or using oral contraceptives, only some of them are facing with SCAD. This suggests the possibility of some hereditary factors, whereas hereditary characteristics may be understood in many different ways like hormone-releasing regulating mechanisms as well as immunity, morphology, or any other mechanism. For instance, autoimmunity has been also a hereditary underlying factor for vessel injury considered in presented cases.

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous Coronary Artery Dissection

Arslan

American Journal of Forensic Medicine &Amp; Pathology

et al. 2015

“…273,274 Sporadically, SCAD may occur in patients with myocardial bridging, a segment of the epicardial coronary descending and traversing in the myocardium. 275,276 Fibromuscular dysplasia has been identified as one of the factors predisposing to SCAD. 277,278 Events may be triggered by severe psychological stress, strenuous exercise, cocaine abuse, fertility hormone treatment, or postmenopausal hormone therapy.…”

Section: Spontaneous Coronary Artery Dissection (Scad)mentioning

confidence: 99%

Endothelin: 30 Years From Discovery to Therapy

2019

Discovered in 1987 as a potent endothelial cell–derived vasoconstrictor peptide, endothelin-1 (ET-1), the predominant member of the endothelin peptide family, is now recognized as a multifunctional peptide with cytokine-like activity contributing to almost all aspects of physiology and cell function. More than 30 000 scientific articles on endothelin were published over the past 3 decades, leading to the development and subsequent regulatory approval of a new class of therapeutics—the endothelin receptor antagonists (ERAs). This article reviews the history of the discovery of endothelin and its role in genetics, physiology, and disease. Here, we summarize the main clinical trials using ERAs and discuss the role of endothelin in cardiovascular diseases such as arterial hypertension, preecclampsia, coronary atherosclerosis, myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) caused by spontaneous coronary artery dissection (SCAD), Takotsubo syndrome, and heart failure. We also discuss how endothelins contributes to diabetic kidney disease and focal segmental glomerulosclerosis, pulmonary arterial hypertension, as well as cancer, immune disorders, and allograft rejection (which all involve ET A autoantibodies), and neurological diseases. The application of ERAs, dual endothelin receptor/angiotensin receptor antagonists (DARAs), selective ET B agonists, novel biologics such as receptor-targeting antibodies, or immunization against ET A receptors holds the potential to slow the progression or even reverse chronic noncommunicable diseases. Future clinical studies will show whether targeting endothelin receptors can prevent or reduce disability from disease and improve clinical outcome, quality of life, and survival in patients.

“…The presence of a myocardial bridge could hypothetically contribute to unleash SCAD in predisposed arteries by mechanical stress 66 67. Yet, given its high prevalence, it would be erroneous to adjudicate the entire responsibility of the SCAD to a myocardial bridge.…”

Section: Patient Profilementioning

confidence: 99%

Spontaneous coronary artery dissection: contemporary aspects of diagnosis and patient management

et al. 2018

Spontaneous coronary artery dissection is an increasingly recognised cause of acute coronary syndromes, especially in young and middle-age women. Recognising its particularities and differences with atherosclerotic disease is central for appropriately identifying and approaching these patients. The authors review the current state of knowledge on spontaneous coronary artery dissection and provide practical recommendations for the diagnosis and management of this condition, both in the acute and convalescence phases.