Spontaneous coronary artery dissection: Case report and evidence for a defect in collagen metabolism

Abstract

Spontaneous coronary artery dissection is a rare disease with a higher prevalence in women, especially in the post-partum state. In one case, we attempted to relate this pathology to a disorder in collagen metabolism. A 32-year-old woman presented two episodes of myocardial infarction, 2 and 4 months after delivery which were shown to be due to two consecutive coronary artery dissections on coronary angiogram. Collagen metabolism was investigated in skin fibroblast cultures derived from the patient, and in control fibroblast cultures. After protein labelling in culture, total protein and collagen synthesis were determined. Quantification of procollagen synthesized in cell cultures and their rate of conversion into collagen were determined both in the culture media and a cell layer extract by DEAE cellulose chromatography. The results showed a reduced total collagen synthesis in the cultures of the patient in comparison with control cultures. The ratio between type I and III procollagen was not altered. The rate of conversion of procollagen into collagen was higher in the pathological cultures than in control cultures. Impaired collagen synthesis due perhaps to a change in hormonal equilibrium in the post-partum state might therefore have been responsible for coronary artery dissection.

Mode of Delivery for a Term Patient with Spontaneous Coronary Artery Dissection

“…It has been noted to mostly affect multiparous women over the age of thirty 13 and commonly involves the left main and left anterior descending arteries 14 . The exact mechanism for this is unknown; however, it is thought that the increased level of progesterone results in structural changes of the vessel walls making them more susceptible to spontaneous dissection [15][16] . With the increased hemodynamic stress of pregnancy and delivery, small tears in the intima of these compromised vessels can occur leading to the dramatic clinical picture that occurs 16 .…”

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

“…Bonnet at al. [5] suggest that low collagen synthesis as in patients with Elhers-Danlos syndrome type IV or III might be responsible for an alteration in the coronary vessel walls, resulting in spontaneous coronary dissection these diseases are known to be due to an inborn defect in collagen metabolism. On the other hand, since an intimal tear was found only infrequently at autopsy, disruption of vasa vasorum leading to intramedial hemorrhage and subsequent dissection without intimal tear has been proposed as a possible mechanism.…”

Spontaneous Coronary Artery Dissection Causing Myocardial Infarction and Left Ventricular Aneurysm.

“…The changes in connective tissue that occur during pregnancy are probably caused by the high estrogen level, 4 but SCAD also occurs in men, leading to the necessity of formulating a multifactorial theory of pathogenesis. 5 Angitis has been implicated in the pathogenesis and Kearney et al 6 reported autopsy cases with eosinophilic infiltration of the adventitia of the involved coronary artery.…”