Multivessel Spontaneous Coronary Artery Dissection in a Patient with Severe Systolic Hypertension: A Possible Association

Abstract

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of myocardial ischemia and infarction. Hypertension has not been associated with SCAD. The authors report multivessel SCAD in an elderly woman with severe systolic hypertension. They postulate that hypertension of this degree may play a pathophysiologic role in the causation of SCAD.

Spontaneous dissection of left main coronary artery associated with hypertensive crisis: A probable fatal complication detected by intravascular ultrasound

“…All of these patients had associated atherosclerosis and their clinical courses were more benign compared to patients with non atherosclerotic SCAD. In addition, SCAD cases have also been reported associated with cocaine use [5], ergotamine use [6], intense physical exercise [7], emotional stress [3], sleep deprivation [8], sexual intercourse [9], severe systolic hypertension [10], and connective tissue disorders as well as others classified as idiopathic due to lack of any apparent triggering factor. In our patient we have recognized left main coronary artery dissection causing unstable angina, in the absence of atherosclerosis detected by IVUS, and possibly triggered by hypertensive crisis.…”

Spontaneous Coronary Artery Dissection Mimicking Acute Aortic Dissection

“…[6][7][8] To the best of our knowledge, the association with hypertension has been reported in 3 cases in English language journals but only 1 case showed a strong association as a contributor to the pathogenesis of SCAD. 3,4,9 In the first case report Greenblatt et al (1999) has reported that severe hypertension might play a pathophysiological role in the development of SCAD. 3 In this report, they described an elderly woman with multivessel SCAD and severely increased LV pressure during the catheterization.…”

“…3,4,9 In the first case report Greenblatt et al (1999) has reported that severe hypertension might play a pathophysiological role in the development of SCAD. 3 In this report, they described an elderly woman with multivessel SCAD and severely increased LV pressure during the catheterization. Here, they considered that severe hypertension may be a causative factor in the development of SCAD.…”

“…Unlike classic aortic dissection, no close association of hypertension has been reported except in only a few case reports. [2][3][4] We report the first case of a 67-year-old man with hypertension, manifesting as typical symptoms and signs of acute aortic dissection, who was finally diagnosed with SCAD involving the right coronary artery. …”

Spontaneous coronary dissection as a cause of acute coronary syndrome: Evidence for non-inflammatory underlying mechanisms

“…It has also been associated with collagen disease [3], cocaine abuse [4], severe hypertension [5], smoking [6], oral contraceptives [7], and severe psychological stress [8].…”