- 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. Early studies of the disease placed mortality rates at around 70%, but more recent evidence suggests a figure of around 20% 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.
Signs and symptoms
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. There is also a possibility that exercise can be a trigger. However cases sometimes have no obvious cause.
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.
A selective coronary angioplasty is the most common method to diagnose the condition, although it is sometimes not recognised until after death. Intravascular ultrasound (IVUS) is also used as it is able to more easily differentiate the condition from atherosclerotic disease.
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. Drug-eluting stents and thrombolytic drug therapy are less invasive options for less severe cases.
Eighty percent of cases are in women, and a third late in pregnancy or shortly after.
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Cardiovascular disease: heart disease · Circulatory system pathology (I00–I52, 390–429) IschaemicActive ischemia LayersValves Conduction/
arrhythmiaPremature contractionWolff-Parkinson-White · Lown-Ganong-LevineFlutter/fibrillationPacemakerOther/ungrouped
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