Spontaneous coronary artery dissection: A single-center case series and literature review

Abreu, Glória; Braga, Carlos Galvão; Costa, João; Azevedo, Pedro; Marques, Jorge

doi:10.1016/j.repce.2017.07.013

Cited by 3 publications

(6 citation statements)

References 20 publications

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“…6 SCAD almost exclusively affects women, more than 90% of the time. 3,[7][8][9][10] Although chest pain remains the most prevalent clinical presentation, SCAD patients may develop a wide variety of symptoms. This includes life-threatening ventricular arrhythmias such as ventricular fibrillation or ventricular tachycardia in up to 7.2% of patients.…”

Section: Case 2-nonpregnancy-associated Scadmentioning

confidence: 99%

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Spontaneous coronary artery dissection: clinical implications and diagnostic challenges. Overlooked and underappreciated in Asia?

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Houdmont

Sim

et al. 2020

Clinical Cardiology

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Over the last decade, spontaneous coronary artery dissection (SCAD) has garnered much attention as a significant cause of acute coronary syndrome (ACS) and sudden cardiac death in women without classic cardiovascular risk factors. SCAD has been mostly studied in the West, with little recognition in Asia leading to under-diagnosis and under-representation. In this review, we highlight two distinct cases occurring at our center in Singapore, affecting two Singaporean women of Malay and Chinese descent. These 2 cases highlight that pregnancy-associated SCAD is neither the most common nor only manifestation of SCAD. Through review of the literature, we emphasize the heterogeneity in case presentation paying particular attention to SCAD and its association with connective tissue disorders such as fibromuscular dysplasia. SCAD remains a diagnostic challenge for many cardiologists, here we shed light and dispel myths surrounding coronary angiography and review the use of intracoronary imaging. The successful treatment of this unique group of patients requires a high index of suspicion, and management within a multidisciplinary team. The development of a recovery program with access to support groups, allied health, and cardiac rehabilitation is paramount in improving outcomes for these patients in the long term. Further research and studies in our Asian population will help to enhance our understanding of this disease and develop practices to best manage our patients. 1 | INTRODUCTION Spontaneous coronary artery dissection (SCAD), once thought to be the veritable unicorn on coronary angiogram, has gained a significant amount of attention in the last decade. Previously labeled to be a rare condition, SCAD has now emerged as an important cause of acute coronary syndrome (ACS) and sudden cardiac death, especially in young and otherwise healthy women without apparent cardiovascular risk factors. SCAD is defined by atraumatic spontaneous dissection of an epicardial coronary artery, which is not related to atherosclerosis or iatrogenic injury. Myocardial injury most frequently results from luminal obstruction by a growing intramural hemorrhage that may be spontaneous or secondary to an intimal tear. Studies have reported the incidence to be between 1.1% and 4% of all ACS, 1,2 and as a cause of 15% and 35% of ACS in women under 50 years old. 3-5 Remarkably, the advances in our understanding of SCAD was to a large extent driven by social media in the West, where stricken female patients Marie Houdmont co first-author.

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Section: Case 2-nonpregnancy-associated Scadmentioning

confidence: 99%

“…In addition, up to 10% of SCAD patients were found to be taking oral contraceptive or hormonal replacement therapies suggesting an important role of hormonal factors in SCAD pathophysiology 6 . SCAD almost exclusively affects women, more than 90% of the time 3,7‐10 …”

Section: Pathophysiology and Two Distinct Clinical Entitiesmentioning

confidence: 99%

Spontaneous coronary artery dissection: clinical implications and diagnostic challenges. Overlooked and underappreciated in Asia?

Low

Houdmont

Sim

et al. 2020

Clinical Cardiology

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“…The proportion of ST segment elevation myocardial infarction (STEMI) and non-STEMI varies significantly among SCAD series: STEMI 26%–87% (weighed average 37 %), non-STEMI 13%–77% (weighed average 63%) 1 3–11. This variation likely owes to the dynamic behaviour of the SCAD lesion and its translation into the ECG.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Single-vessel dissection is the most common anatomical presentation, with only ~10% of SCAD cases presenting with multivessel involvement (the least in non-contiguous vessels). Principal vessels’ territories are affected in the following frequencies (not exclusive): left anterior descending (~57%), left circumflex (~32%), right coronary artery (~23%) and left main (~3%) 1 4–11. Although not homogeneously reported, it is known that SCAD typically presents in mid to distal segments, with about 10% involving proximal vessels 3 4 9 20…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Spontaneous coronary artery dissection (SCAD) is an important non-atherosclerotic aetiology underlying acute coronary syndromes (ACS) or sudden cardiac death in young and middle-age women. Knowledge of the pathophysiology, diagnosis and management of SCAD has exponentially increased over the last years,1–12 leading to more awareness and enhanced recognition by cardiologists worldwide. This also explains the creation of dedicated working groups,13 14 alongside with e-platforms intended to gather patients with SCAD, and get them involved in research projects 15.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Systematic review and meta-analysis of the clinical characteristics and outcomes of spontanous coronary artery dissection

Franke

Nerlekar

Marshall

et al. 2021

International Journal of Cardiology

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Spontaneous coronary artery dissection: A single-center case series and literature review

Cited by 3 publications

References 20 publications

Spontaneous coronary artery dissection: clinical implications and diagnostic challenges. Overlooked and underappreciated in Asia?

Spontaneous coronary artery dissection: clinical implications and diagnostic challenges. Overlooked and underappreciated in Asia?

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

Systematic review and meta-analysis of the clinical characteristics and outcomes of spontanous coronary artery dissection

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