Spontaneous coronary artery dissection history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A. Arzu Kalayci, M.D. [2]
Synonyms and keywords: SCAD
Overview
The hallmark symptom of spontaneous coronary artery dissection (SCAD) is angina pectoris, similar to other acute coronary syndromes, which may radiate to the jaw or left arm. SCAD should be suspected with these symptoms in relatively young women, especially those in postpartum status. However, many patients do not have typical risk factors of coronary artery disease. Patients are typically asymptomatic on follow-up.
History
Patients presenting with typical symptoms of acute coronary syndromes and the following clinical characteristics may have suspected spontaneous coronary artery dissection (SCAD):
- Physical exertion[1]
- Emotional stress[2]
- Women with an average age ranging from 43 to 50 years[3][4]
- Postpartum status or history of pregnancy[5]
- History of smoking
- Atherosclerosis
- Cocaine abuse[6]
- Presence of a Connective tissue disorder: Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome type 4, cystic medial necrosis, alpha-1 antitrypsin deficiency, or polycystic kidney disease[7]
- Many patients do not have a previous history of cardiovascular disease or other risk factors andSCAD is idiopathic.[3]
Symptoms
- The symptoms of SCAD mimic other causes of acute coronary syndromes.
- The most common symptom is an acute and severe onset of chest pain (reported in 85-96% of SCAD patients) characterized by:[8]
- Radiation to the arm (49.5%) and neck (22.1%)
- Associated with nausea and vomiting (23.4%), diaphoresis (20.9%), dyspnea (19.3%), or back pain (12.2%)
- Atypical features such as ‘pleuritic’ (9%),‘tearing’ (1.0%), and ‘positional’ (1%)
- One-fourth of patients have reported recurrent symptoms before seeking medical care.[8]
- Patients may present with:[11]
- Chronic stable angina
- Myocardial infarction[3]
- STEMI (26% to 87%)
- NSTEMI (13% to 69%)
- Cardiogenic shock (2% to 5%)
- Ventricular arrhythmia or sudden cardiac death (3% to 11%)
- Sudden cardiac death due to dissections in the left main coronary artery.[12]
- Pericardial tamponade
- Patients are typically asymptomatic on follow up.[11]
References
- ↑ Azam MN, Roberts DH, Logan WF (1995). "Spontaneous coronary artery dissection associated with oral contraceptive use". Int J Cardiol. 48 (2): 195–8. PMID 7775001.
- ↑ Saw, Jacqueline; Ricci, Donald; Starovoytov, Andrew; Fox, Rebecca; Buller, Christopher E. (2013). "Spontaneous Coronary Artery Dissection". JACC: Cardiovascular Interventions. 6 (1): 44–52. doi:10.1016/j.jcin.2012.08.017. ISSN 1936-8798.
- ↑ 3.0 3.1 3.2 Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D; et al. (2014). "Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes". Circ Cardiovasc Interv. 7 (5): 645–55. doi:10.1161/CIRCINTERVENTIONS.114.001760. PMID 25294399.
- ↑ Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ; et al. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851.
- ↑ Vijayaraghavan, R.; Verma, S.; Gupta, N.; Saw, J. (2014). "Pregnancy-Related Spontaneous Coronary Artery Dissection". Circulation. 130 (21): 1915–1920. doi:10.1161/CIRCULATIONAHA.114.011422. ISSN 0009-7322.
- ↑ Jaffe, Brian D.; Broderick, Thomas M.; Leier, Carl V. (1994). "Cocaine-Induced Coronary-Artery Dissection". New England Journal of Medicine. 330 (7): 510–511. doi:10.1056/NEJM199402173300719. ISSN 0028-4793.
- ↑ Saw, J.; Aymong, E.; Sedlak, T.; Buller, C. E.; Starovoytov, A.; Ricci, D.; Robinson, S.; Vuurmans, T.; Gao, M.; Humphries, K.; Mancini, G. B. J. (2014). "Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes". Circulation: Cardiovascular Interventions. 7 (5): 645–655. doi:10.1161/CIRCINTERVENTIONS.114.001760. ISSN 1941-7640.
- ↑ 8.0 8.1 Kim, Esther S.H.; Longo, Dan L. (2020). "Spontaneous Coronary-Artery Dissection". New England Journal of Medicine. 383 (24): 2358–2370. doi:10.1056/NEJMra2001524. ISSN 0028-4793.
- ↑ Adlam, David; Alfonso, Fernando; Maas, Angela; Vrints, Christiaan; al-Hussaini, Abtehale; Bueno, Hector; Capranzano, Piera; Gevaert, Sofie; Hoole, Stephen P; Johnson, Tom; Lettieri, Corrado; Maeder, Micha T; Motreff, Pascal; Ong, Peter; Persu, Alexandre; Rickli, Hans; Schiele, Francois; Sheppard, Mary N; Swahn, Eva (2018). "European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection". European Heart Journal. doi:10.1093/eurheartj/ehy080. ISSN 0195-668X.
- ↑ Luong, Christina; Starovoytov, Andrew; Heydari, Milad; Sedlak, Tara; Aymong, Eve; Saw, Jacqueline (2017). "Clinical presentation of patients with spontaneous coronary artery dissection". Catheterization and Cardiovascular Interventions. 89 (7): 1149–1154. doi:10.1002/ccd.26977. ISSN 1522-1946.
- ↑ 11.0 11.1 Zampieri P, Aggio S, Roncon L, Rinuncini M, Canova C, Zanazzi G; et al. (1996). "Follow up after spontaneous coronary artery dissection: a report of five cases". Heart. 75 (2): 206–9. PMC 484263. PMID 8673763.
- ↑ Basso C, Morgagni GL, Thiene G (1996). "Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death". Heart. 75 (5): 451–4. PMC 484340. PMID 8665336.