Spontaneous dissection of the left main coronary artery: case report and review of the literature

Alvarez, John M.; Deal, Cedric W.

doi:10.1111/j.1445-5994.1991.tb01417.x

Cited by 19 publications

(12 citation statements)

References 7 publications

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“…As with the previous series, among these new cases left circumflex spontaneous dissection continued to be unusual and left main dissection occurred only in women [3,6,20], Usually this disease is limited to one coronary artery, but it is occasionally seen in more than one vessel. In the series of DeMaio et al [ 1] this was the case in 24% of the women and none of the men diagnosed antemortem, and 19% of the women and 10% of the men found with this condition at autopsy.…”

Section: Discussionmentioning

confidence: 61%

Unique Spontaneous Coronary Artery Dissection in an Elderly Woman

Laslett

Gregoratos²

1995

Cardiology

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Section: Discussionmentioning

confidence: 61%

Unique Spontaneous Coronary Artery Dissection in an Elderly Woman

Laslett

Gregoratos²

1995

Cardiology

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“…Distal emboli with abrupt vessel cut-offs are common [ 42 ] . Unless complicated by lumen thrombosis or death, most spontaneous dissections heal, but permanent true and false channel lumens may persist [ 44,[49][50][51] . A similar dual-lumen vessel can be seen late after angioplasty complicated by a spiral dissection.…”

Section: Spontaneous Coronary Artery Dissectionmentioning

confidence: 98%

“…At angiography, spontaneous dissection appears as a radiolucent linear filling defect that spirals down the coronary artery [ 37,39,42,[49][50][51] . After intracoronary contrast injection, contrast material frequently persists in the false lumen.…”

Section: Spontaneous Coronary Artery Dissectionmentioning

confidence: 99%

“…In young patients with systemic lupus erythematosus and no important risk factors for atherosclerosis, coronary lesions and myocardial infarction should be assumed to be due to vasculitic involvement of the coronary arteries until shown otherwise, although accelerated atherosclerosis due to corticosteroid therapy may also account for angiographically detected lesions. Late aneurysmal dilation of the large coronary arteries, especially in periarteritis nodosa, has been reported to occur in nearly all of the vasculitic syndromes, and rupture of the aneurysm has been reported as a rare consequence [ 44,46,50 ] .…”

Section: Coronary Abnormalities Associated With Vasculitismentioning

confidence: 99%

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Nonatherosclerotic Ischemic Heart Disease

Valeti

Wilson

Vlodaver

2011

Coronary Heart Disease

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Spontaneous coronary vasospasm leads to an anginal syndrome (often referred to as Printzmetal angina), occurring at rest or with exertion. Coronary spasm occurs in two broad settings -spasm associated with atherosclerosis or other arterial diseases, and spasm that occurs in the absence of identifiable arteriopathy [1][2][3][4][5] . The former is common, but the latter is not [ 1 ] . Bertrand administered ergonovine, a compound that precipitates spasm in predisposed individuals, to 1,089 patients undergoing coronary arteriography and found that spasm was relatively common in patients with recent coronary thrombosis ( Fig. 20.1 ) [ 3 ] . Vasospasm could be induced in 20% of patients with a recent infarction and 38% of patients with unstable or rest angina, but in only 4.3% of patients with stable, exertional angina. Equally important, only 1.2% of patients with chest pain atypical for angina had inducible spasm, emphasizing that spasm is not a common cause of atypical chest pain.Patients with inducible vasospasm and a significant (>75%) stenotic lesion have a higher incidence of death, infarction, and atherosclerosis progression than patients with isolated stenotic lesions without inducible vasospasm or vasospasm alone [6][7][8] . Harding et al. [ 9 ] retrospectively analyzed ergonovine provocative studies and found that smoking (odds ratio 4.7-7.7:1 compared to nonsmokers) and atherosclerosis were significant risk factors for inducible spasm [ 9,10 ] . More recently, vascular inflammation, polymorphism of eNOS genes, and enhanced phospholipase C activity have been linked to coronary spasm [ 11,12 ] . The diagnosis of coronary vasospasm can be made at the time of angiography by giving drugs that provoke spasm or occasionally by observing spontaneous spasm [ 1,2,[13][14][15][16][17][18] . The most commonly administered agent is an ergot derivative, usually ergonovine maleate or ergometrine, although methacholine was used to induce vasospasm in pioneering studies in the catheterization laboratory. Ergot derivatives are potent constrictors of vascular smooth muscle. Muscarinic receptor agonists (acetylcholine and methacholine) appear to cause vasospasm in a large fraction of patients with ergonovine-induced spasm [ 19 ] . Other agents have also been reported to induce spasm (cold pressor test, histamine, hyperventilation), but not enough information is known to assess the potency and specificity of these agents [ 20,21 ] .Prior to a provocative test for vasospasm, an electrocardiogram should be obtained and a coronary arteriogram should show the absence of severe coronary obstruction. When vasospasm is suspected, acetylcholine or ergonovine generally is given in incremental intravenous doses -starting at 50 m g and increasing doses until a total dose of 350-400 m g intravenously is reached for ergonovine. Although ergonovine appears safe in doses up to 800 m g, the vast majority of patients

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“…[1,2] Multiparity and twin pregnancies, which can result in hemodynamic stress from pregnancy-related volume overloading, and endothelial dysfunction are considered to be the main risk factors associated with PSCAD. [3,4] In the acute phase, an urgent coronary angiography and an intravascular ultrasound are recommended for the diagnosis and its treatment. [5] Medical or conservative therapy, percutaneous coronary intervention (PCI), or CABG have been suggested.…”

mentioning

confidence: 99%

Postpartum spontaneous coronary artery dissection

Kayançiçek¹

2017

Turk Gogus Kalp Dama

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ÖZSpontan koroner arter diseksiyonu, doğum sonrası dönemde miyokard infarktüsünün nadir bir nedenidir. Çok doğum yapanlarda ve ikiz gebeliklerde artmış hormonal yük ve hemodinamik strese bağlı olarak spontan koroner arter diseksiyonu riskini artırdığı düşünülmektedir. Günümüzde optimum tedaviye ilişkin bir konsensüs olmamasına rağmen, konservatif tedavi, koroner arter baypas greftleme ve perkütan koroner girişim kullanılmaktadır. Postpartum dönemde spontan koroner arter diseksiyonlu dört olgu sunulmaktadır.Anah tar söz cük ler: Koroner arter baypas greftleme; koroner arter diseksiyonu; koroner arter stentleme; gebelik. ABSTRACTSpontaneous coronary artery dissection in the postpartum period is a rare cause of myocardial infarction. Multiparity and twin pregnancies are thought to increase the risk of spontaneous coronary artery dissection due to increased hormonal burden and hemodynamic stress. Although there is no consensus on the optimal treatment currently, conservative management, coronary artery bypass grafting, and percutaneous coronary intervention are used. We present four cases with spontaneous coronary artery dissection in the postpartum period.

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Spontaneous dissection of the left main coronary artery: case report and review of the literature

Abstract: Primary coronary artery dissection is a rare cause of myocardial infarction. It should be suspected in young, healthy females. It is a condition which is treated by myocardial revascularisation.

Cited by 19 publications

References 7 publications

Unique Spontaneous Coronary Artery Dissection in an Elderly Woman

Unique Spontaneous Coronary Artery Dissection in an Elderly Woman

Nonatherosclerotic Ischemic Heart Disease

Postpartum spontaneous coronary artery dissection

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