STEMI in a young female? Consider spontaneous peripartum coronary artery dissection

Ghaffarian, Kenn; Furin, Molly; Bassett, Robert A.

doi:10.1016/j.ajem.2016.08.064

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Chest pain or an ACS equivalent in a young peripartum woman without traditional cardiac risk factors should prompt an emergency physician to consider PASCAD. 3,12 This diagnosis is often overlooked and needs to be added to the list of serious etiologies for chest pain in a young patient such as pulmonary embolism, MI, or aortic dissection. SCAD is an important cause of ACS in women, accounting for 24% to 35% of MI in women under the age of 50.…”

Section: Resultsmentioning

confidence: 99%

“…1,2 These patients may present to emergency rooms, yet this diagnosis receives limited attention among the emergency medicine community. 3 Although PASCAD can be seen at any trimester in pregnancy and up to months postpartum, the majority of cases have been reported in the third trimester or early postpartum period defined as within 6 weeks of delivery. 2,4 Abnormal electrocardiogram (ECG) changes, elevated troponins, and regional wall motional abnormalities on echocardiography are all diagnostic findings of PASCAD, which can be ultimately confirmed with coronary angiography.…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy-associated spontaneous coronary artery dissection (PASCAD): An etiology for chest pain in the young peripartum patient

Lee

Carr

2018

CJEM

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Cardiac emergencies in pregnancy and the postpartum period are rare but often life-threatening. An emergency physician's differential diagnosis for chest pain in the peripartum patient often includes serious etiologies such as pulmonary embolism or myocardial infarction (MI). A lesser-known but important consideration on the differential for MI is that of a spontaneous coronary artery dissection (SCAD). SCAD is defined as an intramural hematoma within the coronary artery that compresses the true lumen. Expansion by increased pressures may lead to subsequent myocardial ischemia and infarction. This condition is the most common cause of pregnancy-associated MI and is reported as the cause of MI in 24% to 35% of all women younger than 50 years. This condition is predominately seen in young healthy females with no traditional risk factors for coronary artery or cardiac disease, and typically in the postpartum period. SCAD in the peripartum period is defined as pregnancy-associated spontaneous coronary artery dissection (PASCAD). Abnormal ECG changes, elevated troponins, and regional wall motional abnormalities on echocardiography are all diagnostic findings of SCAD, which can be ultimately confirmed with coronary angiography. Failure to immediately address this condition can lead to acute heart failure, cardiogenic shock, and death. Thrombolytic treatment may be harmful and is not recommended, and percutaneous coronary intervention can result in the iatrogenic propagation of further coronary dissection. As a result, the management for suspected SCAD involves emphasis on urgent transfer and urgent coronary artery angiography to determine appropriate treatment modalities.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pregnancy-associated spontaneous coronary artery dissection (PASCAD): An etiology for chest pain in the young peripartum patient

Lee

Carr

2018

CJEM

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“…SCAD has no pathognomic risk factors. It was noticed that, SCAD more often affects young women who do not have cardiovascular factors for cardiovascular disease (6)(7)(8). It is currently thought that risk factors for SCAD are multiple pregnancies (more than 4 times), administration of hormone replacement therapy, infertility therapy, connective tissue diseases, in particular, fibromuscular dysplasia, vascular Ehlers-Danlos syndrome, Marfan syndrome, Loeys-Dietz syndrome, emotional and physical stress (2,(9)(10)(11)(12).…”

Section: Methodsmentioning

confidence: 99%

Brief Summary of Pathogenesis, Diagnosis and Management of Spontaneous Coronary Artery Dissection

Rėkus¹,

Jaruševičius²

2020

Health Sciences

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Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). It was first described 80 years ago. Pathogenetic mechanisms are most likely to be associated with intimas tear or bleeding vasa-vasorum, which resulting in intramural haemorrhage. SCAD typically occurs in young women who do not have coronary heart disease risk factors and who have acute coronary syndrome. Half of all SCAD presents with ST – elevation myocardial infarction (STEMI), while the rest with non – ST – elevation myocardial infarction (NSTEMI). The gold standard method for diagnosis is interventional coronary artery angiography. After the acute ischemic onset syndrome, most patients have a stable, benign clinical course, and eventually experience spontaneous vessel wall healing. Therefore, conservative treatment (a watchful strategy) is recommended as the initial treatment. For the majority of cases as interventional and surgical treatment in most cases seems to be suboptimal. In this extremely complex situation, several novel and attractive coronary interventions have been proposed. The risk factors, pathogenesis theories, diagnosis, management, prognosis of SCAD will be summarized in this review.

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Spontaneous dissection in the left main coronary artery

Shan

Huang

Hoosen

et al. 2018

The American Journal of Emergency Medicine

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STEMI in a young female? Consider spontaneous peripartum coronary artery dissection

Cited by 3 publications

References 11 publications

Pregnancy-associated spontaneous coronary artery dissection (PASCAD): An etiology for chest pain in the young peripartum patient

Pregnancy-associated spontaneous coronary artery dissection (PASCAD): An etiology for chest pain in the young peripartum patient

Brief Summary of Pathogenesis, Diagnosis and Management of Spontaneous Coronary Artery Dissection

Spontaneous dissection in the left main coronary artery

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