Spontaneous Coronary Artery Dissection

Thayer, John O.; Healy, Robert W.; Maggs, Peter R.

doi:10.1016/s0003-4975(10)62372-7

Cited by 135 publications

(88 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thrombolysis has been given in a few cases with favorable outcome including our patient [6][7][8] but is not recommended when the diagnosis is made on coronary angiography, as it may cause propagation of the dissection and expansion of the intramural hematoma [2,9,10]. Treatment-wise, an early report by Thayer et al [11] recommended bypass grafting for all patients with spontaneous dissection. However, according to DeMaio et al [1] we agree that, as with any case of severe left main coronary artery disease caused by either atherosclerosis or dissection coronary bypass grafting should be performed.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection in an antilles man with acute inferior myocardial infarction

Pierre-Justin

Piérard²

2007

International Journal of Cardiology

View full text Add to dashboard Cite

Spontaneous coronary artery dissection is a rare cause of myocardial infarction. It has been reported mainly in young women during or after pregnancy. The diagnosis is usually confirmed at autopsy. The management of these patients remains controversial. We report the case of a patient who presented spontaneous dissection and was with successfully treated by thrombolysis. Clinical outcome was good. © 2006 Elsevier Ireland Ltd. All rights reserved.Keywords: Coronary dissection; Myocardial infarction; Thrombolysis Spontaneous coronary artery dissection is a rare cause of myocardial infarction, occurring as complication aortic dissection or occurring after blunt, chest trauma, coronary bypass grafting, cardiac catheterisation or coronary angioplasty. The diagnosis is frequently obtained at autopsy. The management is not yet well codified. We report the case of a patient who presented spontaneous dissection, with a good outcome after thrombolysis. Case report55-year old Antilles man, without previous cardiac history, was admitted in the intensive care unit for acute inferior myocardial infarction. Physical examination revealed blood pressure of 150/90 mmHg , pulse rate of 64/min , a respiratory rate of 18/min and a normal cardiovascular examination serial electrocardiograms revealed inferior Q wave myocardial infarction, confirmed by characteristic increase and decrease of creatine-Kinase with peak serum level of 1474 IU/l. Chest X-ray was normal. He received intravenous tissue plasminogen activator 5 h after the onset of pain followed by resolution of chest pain rapid resolution and of ST segment elevation (Figs. 1 and 2). Twodimensional echocardiography revealed hypokinesia of the inferior wall. A first catheterisation was performed 12 days later. Hypokinesia of left ventricular inferior wall was found at angiography. Coronary arteriography demonstrated a floating intimal flap in the right coronary artery indicating coronary artery dissection. No atherosclerotic plaque was observed. (Fig. 3). The collagen screen was negative for auto-immune disorders. Doppler of the carotid arteries and thoracoabdominal CT scan were normal. Twelve days later, the patient was discharged from the hospital on medical therapy. Follow-upAngiographic follow-up was performed 5 months later; there was no residual sign (Fig. 4). On a subsequent treadmill test, he achieved stage 4 of a standard Bruce protocol without symptoms or inducible ischemia. Dobutamine stress echocardiography and MIBI single photon emission tomography were normal. The patient had no symptoms throughout 18-month follow-up.

show abstract

Section: Discussionmentioning

confidence: 99%

Spontaneous coronary artery dissection in an antilles man with acute inferior myocardial infarction

Pierre-Justin

Piérard²

2007

International Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…2,8,9,47 Antemortem diagnosis is confirmed with coronary angiography, 2, 65 and the presence of extraluminal radiolucent contrast after washout of dye from the remainder of the vessel as well as a radiolucent intimal flap are indicators of dissection (Fig. 1).…”

Section: Diagnosismentioning

confidence: 94%

“…4,11,[43][44][45] Coronary artery dissection can occur secondary to atherosclerosis after rupture of a plaque or vasa vasorum. 16,46,47 Nevertheless, some authors have suggested that atherosclerosis itself may prevent SCAD via a stenting effect, whereby scarring and atrophy of the media prevents extension of the dissection and may be associated with improved collateral circulation.…”

Section: Etiology and Pathogenesismentioning

confidence: 99%

Spontaneous coronary artery dissection

Almeda

Barkatullah

Kavinsky

2004

Clinical Cardiology

101

View full text Add to dashboard Cite

Summary: Spontaneous coronary artery dissection (SCAD)is an unusual cause of acute myocardial ischemia with complex pathophysiology. This paper reviews the major diagnostic and therapeutic issues of this rare but important disease. The diagnosis of SCAD should be strongly considered in any patient who presents with symptoms suggestive of acute myocardial ischemia, particularly in young subjects without traditional risk factors for coronary artery disease (especially in young women during the peripartum period or in association with oral contraceptive use). Urgent coronary angiography is indicated to establish the diagnosis and to determine the appropriate therapeutic approach. The decision to pursue medical management, percutaneous coronary intervention, or surgical revascularization is based primarily on the clinical presentation, extent of dissection, and amount of ischemic myocardium at risk.

show abstract

“…TARTIŞMA SKAD'nin klinik yansıması olguların büyük kıs-mında (%70-75) ani kardiyak ölüm şeklinde olmakta ve tanısı ancak otopsi ile konabilmektedir. 2,3 Yaşayan hastalarda ise SKAD'nin tanısı koroner anjiyografi ile konur ve sıklığı %0.1-1.1 arasında bildirilmiştir. 2,4 Hastaların %70'inde LAD, %20 'sinde RCA, %4'ünde Cx ve %1'inden daha azında LMCA tutulur.…”

Section: öZetunclassified

Succesful treatment of spontaneous dissection of the coronary artery by primary percutaneous coronary intervention

Yazici

Nasifov²,

Mert³

et al. 2011

J Clin Exp Invest

View full text Add to dashboard Cite

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction. The disease is usually seen in young-middle aged women and leads to sudden death in the majority of cases. In survived patients, diagnosis of SCAD has been made with coronary anjiography. Involvement of left main coronary artery (LMCA) is very unusual. We describe on a case of SCAD involving the LMCA in a young woman presenting with an acute myocardial infarction and cardiogenic shock status. There were no risk factors for coronary artery disease and no evidence of atherosclerosis on angiography. Coronary angiography revealed dissection of the LMCA that extended into the anterior descending and circumflex coronary arteries. The dissection was successfully treated with primary coronary artery stenting. The patient was discharged without complication. There was no problem in the first evaluation at the end of the first of the month. GİRİŞSpontan koroner arter diseksiyonu (SKAD), akut miyokard infarktüsü ve ani ölüme neden olabilen nadir bir durumdur.1 Hastalık sıklıkla genç-orta yaştaki kadınlarda görülür. En sık sol ön inen koroner arter (LAD) tutulurken sol ana koroner arterin (LMCA) tutulumu ise son derece nadirdir. Burada, spontan LMCA diseksiyonuna bağlı akut miyokard infarktüsü ve kardiyojenik şok tablosunda başvurup primer perkütan girişimle başarılı tedavisi yapılan bir olgu sunuldu. OLGUOtuz altı yaşında kadın hasta ani başlayan nefes darlığı ve göğüs ağrısı şikayeti ile acil servise başvur-du. Koroner arter hastalığı için risk faktörü yoktu. Hastanın arteriyal kan basıncı 60/40 mmHg, kalp hızı 120/dk idi. Elektrokardiyografisinde aVR ve V1 derivasyonlarında 2 mm ST elevasyonu, inferiyor ve anteriyor derivasyonlarda 2-3 mm yaygın ST depresyonu saptandı (Resim 1). Acil serviste ventrikül fibrilasyonu gelişen hastaya 360 joule ile bir kez defibrilasyon işlemi uygulandı. Kardiyojenik şok tablosunda anjiyografi laboratuvarına alınan hastanın koroner anjiyografisinde LMCA distalinin

show abstract

Spontaneous Coronary Artery Dissection

Cited by 135 publications

References 34 publications

Spontaneous coronary artery dissection in an antilles man with acute inferior myocardial infarction

Spontaneous coronary artery dissection in an antilles man with acute inferior myocardial infarction

Spontaneous coronary artery dissection

Succesful treatment of spontaneous dissection of the coronary artery by primary percutaneous coronary intervention

Contact Info

Product

Resources

About