Coronary artery dissection

Coronary artery dissection
Classification and external resources
ICD-10	I25.4
ICD-9	414.12
DiseasesDB	3115

A coronary artery dissection (also known as spontaneous coronary artery dissection, or SCAD) is a rare, sometimes fatal traumatic condition, with eighty percent of cases affecting women. The coronary artery develops a tear, causing blood to flow between the layers which forces them apart.^[1] Early studies of the disease placed mortality rates at around 70%, but more recent evidence suggests a figure of around 20%^[2][3] The condition is often seen to be related to female hormone levels, as well as other pre-existing cardiovascular conditions. In addition to this, a dissection can occur iatrogenically, by the surgical inserion of a catheter into the coronary artery.^[4]

Signs and symptoms

The symptoms are often very similar to those of myocardial infarction (heart attack), with the most common being persistent chest pain.^[5]

Causes

SCAD

There is evidence to suggest that a major cause of spontaneous coronary artery dissection (SCAD) is related to female hormone levels, as most cases appear to arise in pre-menopausal women, although there is evidence that the condition can have various triggers; other underlying conditions such as hypertension may sometimes be causes.^[6] There is also a possibility that exercise can be a trigger. However cases sometimes have no obvious cause.^[7]

Iatrogenesis

It has been recognised that some instances are iatrogenic, as it can be caused by the insertion of a catheter into the coronary artery.^[4]

Pathophysiology

Coronary artery dissection results from a tear in the inner layer of the artery, the tunica intima. This allows blood to penetrate and cause an intramural hematoma in the central layer, the tunica media, and a restriction in the size of the lumen, resulting in reduced blood flow which in turn causes myocardial infarction and can later cause sudden cardiac death.^[8][9]

Diagnosis

A selective coronary angioplasty is the most common method to diagnose the condition, although it is sometimes not recognised until after death.^[10] Intravascular ultrasound (IVUS) is also used as it is able to more easily differentiate the condition from atherosclerotic disease.^[11]

Treatment

Treatment is varied depending upon the nature of the case. In severe cases, coronary artery bypass surgery is performed to redirect blood flow around the affected area.^[12] Drug-eluting stents and thrombolytic drug therapy are less invasive options for less severe cases.^[11]

Epidemiology

Eighty percent of cases are in women, and a third late in pregnancy or shortly after. 

See also

• Dissection (medical)
• Aortic dissection, a similar condition affecting a different artery

References

1. ^ Robert Slight; Ali Asgar Behranwala; Onyekwelu Nzewi; Rajesh Sivaprakasam; Edward Brackenbury; Pankaj Mankad (2003) "Spontaneous coronary artery dissection: a report of two cases occurring during menstruation" New Zealand Medical Journal]
2. ^ Umman, Sabahattin; Olcay, Ayhan; Sezer, Murat; Erdogan, Dogan (2006) "Exercise-induced coronary artery dissection treated with an anticoagulant and antiaggregants" The Anatolian Journal of Cardiology
3. ^ Monika Juszczyk MD; Thomas Marnejon; David A. Hoffman; (2004) "Spontaneous Coronary Artery Dissection Postpartum" Invasive Cardiology
4. ^ ^{a b} Andrew Boyle; Michael Chan; Joud Dib; Jon Resar (2006) "Catheter-Induced Coronary Artery Dissection: Risk Factors, Prevention and Management" Inavasive Cardiology
5. ^ "Spontaneous Coronary Artery Dissection Postpartum"
6. ^ Dhawan R, Singh G, Fesniak H. (2002) "Spontaneous coronary artery dissection: the clinical spectrum". Angiology
7. ^ Mark V. Sherrid; Jennifer Mieres; Allen Mogtader; Naresh Menezes; Gregory Steinberg (1995) "Onset During Exercise of Spontaneous Coronary Artery Dissection and Sudden Death. Occurrence in a Trained Athlete: Case Report and Review of Prior Cases" Chest
8. ^ Virmani R, Forman MB, Rabinowitz M, McAllister HA (1984) "Coronary artery dissections" Cardiol Clinics
9. ^ Kamineni R, Sadhu A, Alpert JS. (2002) "Spontaneous coronary artery dissection: Report of two cases and 50-year review of the literature" Cardiol Rev
10. ^ C. Basso, G. L. Morgagni, G. Thiene (1996) "Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death" BMJ
11. ^ ^{a b} Intravascular Ultrasound Imaging in the Diagnosis and Treatment: The Future: IVUS-Guided DES Implantation?
12. ^ MedHelp:Coronary artery dissection treatment

External links

• "Spontaneous Coronary Artery Dissection Postpartum"