Spontaneous Coronary Artery Dissection Secondary to Rheumatological Diseases: A Comprehensive Review

Ullah, Waqas; Ali, Zain; Khanal, Shristi; Khan, Mariya; Gajanan, Ganesh; Sattar, Yasar; Mukhtar, Maryam; Figueredo, Vincent M.

doi:10.7759/cureus.5231

Cited by 5 publications

(7 citation statements)

References 23 publications

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“…11 Ullah et al conducted a systematic review of 10 articles about SCAD associated with rheumatologic conditions and found that many cases were associated with systemic lupus, most patients presented with non-ST elevation myocardial infarction involving the left main coronary artery, and the majority were managed with stenting. 15 Mortality was <20%.…”

Section: Discussionmentioning

confidence: 96%

Spontaneous Coronary Artery Dissection With Systemic Lupus Erythematosus

Chaaban

Kshatriya

2022

TOJ

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Background: Spontaneous coronary artery dissection (SCAD) has been reported to be a rare cause of acute coronary syndrome and sudden cardiac death. The clinical presentation of SCAD varies from asymptomatic to sudden death. Pregnancy is associated with SCAD, and autoimmune diseases, especially systemic lupus erythematosus (SLE), may play an important role in SCAD etiology. Case Report: A 37-year-old female with hypertension, SLE, a history of preeclampsia with 3 cesarean deliveries, and an active smoking habit presented to the emergency department with chest pain. On arrival, the patient was hypertensive with blood pressure of 152/122 mm Hg and a normal heart rate and respiratory rate. Given the patient's history of SLE and preeclampsia, antiphospholipid antibodies were tested. The anti-β 2 -glycoprotein 1 immunoglobulin G concentration was elevated at 30 U/mL, and lupus anticoagulant was positive. Electrocardiogram showed minimum ST elevation in lead V2. Initial troponin was 0.1 ng/mL, with a peak of 54.5 ng/mL after 6 hours. Aspirin 325 mg was administered, and the patient underwent urgent cardiac catheterization. Intravascular angiography showed evidence of intimal flap (mid left anterior descending artery) spontaneous dissection with subintimal hematoma. The angioplasty resulted in successful stent placement in the mid left anterior descending artery. Conclusion: SCAD diagnosis is challenging and requires a high index of suspicion. This case shows the challenge of early diagnosis of SCAD and highlights its association with autoimmune diseases, specifically SLE. Early recognition of this pathology results in better outcomes.

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Section: Discussionmentioning

confidence: 96%

Spontaneous Coronary Artery Dissection With Systemic Lupus Erythematosus

Chaaban

Kshatriya

2022

TOJ

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“…Ullah et al systematically reviewed 10 articles about SCAD associated with rheumatologic conditions and found that many cases were related to systemic lupus. Furthermore, most patients presented with non-ST elevation myocardial infarction involving the left main coronary artery [ 48 ]. SCAD is an underdiagnosed disease that requires a high index of suspicion.…”

Section: Reviewmentioning

confidence: 99%

Systemic Lupus Erythematosus and Cardiovascular Diseases: A Systematic Review

Nor¹,

Ogedegbe²,

Barbarawi³

et al. 2023

Cureus

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Systemic lupus erythematosus (SLE) is an autoimmune condition characterized by multi-organ involvement. The clinical presentation often varies from mild to moderate to severe. The cardiovascular system may also be affected, often portending a poor prognosis for patients. Although the relationship between SLE and cardiovascular disorders has been extensively explored through case reports and literature reviews, few systematic reviews explicitly focusing on this association have been conducted. In light of this, this systematic review aims to analyze the extent of the association between SLE and cardiovascular diseases (CVDs), by exploring the risk of developing CVDs, including myocardial infarction (MI), atherosclerosis, myocarditis, pericarditis and arrhythmias, in SLE patients vs. non-SLE patients. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform the systematic review. A detailed search was done covering the period from March 2003 to March 2023 using three databases: PubMed, Google Scholar, and Cochrane. The PubMed search identified 597 articles, while Google Scholar and Cochrane searches yielded 559 and three articles, respectively. Of the 1159 articles retrieved, we chose eight for final consideration, after excluding papers that did not discuss the role of SLE in CVDs, papers published earlier than 2003, and papers with incomplete data. The eight studies chosen included two narrative reviews, two systematic reviews, and four observational studies. In this systematic review, SLE was proven to have a strong relationship with diverse CVDs, including rare ones scarcely discussed in the literature, such as vasculitis and aortic dissection. All eight of the final papers indicated a connection between SLE and CVDs, based on the systematic analysis of these articles, which revealed that most recent research supports a higher risk of peripheral arterial occlusive disease (PAOD), MI, pericarditis, myocarditis, and other cardiovascular disorders in individuals with SLE. These associations may have certain gray areas, as patient characteristics and comorbidities often affect the extent of illness and long-term prognosis. Larger-scale studies are required to probe this relationship further and research the etiopathogenesis involved in order to improve patient outcomes. The effects of SLE on the heart are, however, unequivocal.

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“…Pada penelitian kohort eropa dengan populasi besar didapatkan 45% berhubungan penyakit fibromuscular dysplasia (FMD) dan PHACTR1 dikonfirmasi sebagai genetik yang berhubungan dengan SCAD [16]. Penelitian rheumatologi didapatkan Lupus Eritematosus Sistemik (LES) yang paling berkaitan dengan SCAD [17]. SCAD juga memiliki hubungan terhadap beberapa penyakit FMD, gagal ginjal kronis, peripheral artery disease (PAD), carotid artery disease [18].…”

Section: Patofisiologiunclassified

Diseksi Spontan Arteri Koroner: Diagnosis dan Manajemen

Laksono¹,

Subandra²

2023

J. Sains Kes.

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Diseksi spontan arteri koroner (Spontaneous Coronary Artery Dissection: SCAD) salah satu penyebab kasus SKA yang jarang tetapi meningkat insidensi pada wanita muda dengan penilaian risiko kardivaskular rendah. Selain itu SCAD memiliki faktor risiko terhadap kehamilan, dan penyakit fibromuscular dysplasia. Penegakan diagnosis SCAD dengan angiografi koroner menjadi tantangan dikarenakan karakteristik SCAD yang mirip dengan penyebab ACS lainnya dan sering kali terlewat. Diharapkan SCAD dapat menjadi perhatian penelitiaan untuk mendukung penegakan diagnosis dan manajemen guna menghasilkan keluaran lebih baik.

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Spontaneous Coronary Artery Dissection Secondary to Rheumatological Diseases: A Comprehensive Review

Cited by 5 publications

References 23 publications

Spontaneous Coronary Artery Dissection With Systemic Lupus Erythematosus

Spontaneous Coronary Artery Dissection With Systemic Lupus Erythematosus

Systemic Lupus Erythematosus and Cardiovascular Diseases: A Systematic Review

Diseksi Spontan Arteri Koroner: Diagnosis dan Manajemen

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