Spontaneous coronary artery dissection causes: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
Line 19: Line 19:
===Takotsubo Cardiomyopathy===
===Takotsubo Cardiomyopathy===


Both TCM and SCAD affect predominantly women and may be precipitated by [[emotional stress]] or [[exercise|strenuous exercise]] associated with [[sympathetic nerve|sympathetic]] discharge.  Numerous reports have described the concurrence of TCM and SCAD.<ref name="ChouSedlak2015">{{cite journal|last1=Chou|first1=Annie Y.|last2=Sedlak|first2=Tara|last3=Aymong|first3=Eve|last4=Sheth|first4=Tej|last5=Starovoytov|first5=Andrew|last6=Humphries|first6=Karin H.|last7=Mancini|first7=G.B. John|last8=Saw|first8=Jacqueline|title=Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Cardiomyopathy: A Case Series|journal=Canadian Journal of Cardiology|volume=31|issue=8|year=2015|pages=1073.e5–1073.e8|issn=0828282X|doi=10.1016/j.cjca.2015.03.018}}</ref><ref name="Y-HassanHenareh2013">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Henareh|first2=Loghman|title=Spontaneous coronary artery dissection triggered post-ischemic myocardial stunning and takotsubo syndrome: two different names for the same condition|journal=Cardiovascular Revascularization Medicine|volume=14|issue=2|year=2013|pages=109–112|issn=15538389|doi=10.1016/j.carrev.2012.11.005}}</ref><ref name="Y-HassanThemudo2017">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Themudo|first2=Raquel|last3=Maret|first3=Eva|title=Spontaneous coronary artery dissection and takotsubo syndrome: The chicken or the egg causality dilemma|journal=Catheterization and Cardiovascular Interventions|volume=89|issue=7|year=2017|pages=1215–1218|issn=15221946|doi=10.1002/ccd.26956}}</ref><ref name="Y-HassanBöhm2016">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Böhm|first2=Felix|title=The causal link between spontaneous coronary artery dissection and takotsubo syndrome: A case presented with both conditions|journal=International Journal of Cardiology|volume=203|year=2016|pages=828–831|issn=01675273|doi=10.1016/j.ijcard.2015.11.047}}</ref><ref name="YaltaUcar2016">{{cite journal|last1=Yalta|first1=Kenan|last2=Ucar|first2=Fatih|last3=Yilmaztepe|first3=Mustafa|last4=Ozkalayci|first4=Flora|title=Tako-tsubo cardiomyopathy and spontaneous coronary artery dissection: A subtle association with prognostic implications?|journal=International Journal of Cardiology|volume=202|year=2016|pages=174–176|issn=01675273|doi=10.1016/j.ijcard.2015.08.152}}</ref>  In the setting of TCM, vigorous contraction of the left ventricular base in conjunction with the adjacent akinetic/dyskinetic segments could form a prerequisite anatomic/functional substrate for the causation of SCAD.<ref name="Madias2015">{{cite journal|last1=Madias|first1=John E.|title=On a Plausible Association of Spontaneous Coronary Artery Dissection and Takotsubo Syndrome|journal=Canadian Journal of Cardiology|volume=31|issue=11|year=2015|pages=1410.e1|issn=0828282X|doi=10.1016/j.cjca.2015.07.720}}</ref>  The [[coronary dissection]] plane may develop as a result of excessive movement of the epicardial vessels and increased shear stress on the vessel wall at the hinge point between the hyperdynamic and [[dyskinetic]]/[[akinesia|akinetic]] [[myocardium]].  It has also been speculated that the [[coronary arteries]] traversing the anterior or anterolateral wall would be more vulnerable to dissection as this region marks the transition point of the hyperdynamic basal segment and the remaining [[dyskinetic]]/[[akinesia|akinetic]] [[left ventricular]] segments.  Another plausible mechanism is that elevated [[catecholamine]] concentrations in TCM may cause epicardial [[coronary]] [[vasoconstriction]] and/or [[coronary spasm|spasm]], which in turn leads to increased arterial shear stress and subsequent intimal rupture or disruption of [[vasa vasorum]].<ref name="PellicciaKaski2017">{{cite journal|last1=Pelliccia|first1=Francesco|last2=Kaski|first2=Juan Carlos|last3=Crea|first3=Filippo|last4=Camici|first4=Paolo G.|title=Pathophysiology of Takotsubo Syndrome|journal=Circulation|volume=135|issue=24|year=2017|pages=2426–2441|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.116.027121}}</ref>  On the contrary, it is noteworthy that the post-ischemic [[myocardial stunning]] associated with SCAD could lead to TCM,<ref name="Y-HassanHenareh2013">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Henareh|first2=Loghman|title=Spontaneous coronary artery dissection triggered post-ischemic myocardial stunning and takotsubo syndrome: two different names for the same condition|journal=Cardiovascular Revascularization Medicine|volume=14|issue=2|year=2013|pages=109–112|issn=15538389|doi=10.1016/j.carrev.2012.11.005}}</ref> thus forming the “TCM begets SCAD, and SCAD begets TCM” vicious cycle.
Both TCM and SCAD affect predominantly women and may be precipitated by [[emotional stress]] or [[exercise|strenuous exercise]] associated with [[sympathetic nerve|sympathetic]] discharge.  Numerous reports have described the concurrence of TCM and SCAD.<ref name="ChouSedlak2015">{{cite journal|last1=Chou|first1=Annie Y.|last2=Sedlak|first2=Tara|last3=Aymong|first3=Eve|last4=Sheth|first4=Tej|last5=Starovoytov|first5=Andrew|last6=Humphries|first6=Karin H.|last7=Mancini|first7=G.B. John|last8=Saw|first8=Jacqueline|title=Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Cardiomyopathy: A Case Series|journal=Canadian Journal of Cardiology|volume=31|issue=8|year=2015|pages=1073.e5–1073.e8|issn=0828282X|doi=10.1016/j.cjca.2015.03.018}}</ref><ref name="Y-HassanHenareh2013">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Henareh|first2=Loghman|title=Spontaneous coronary artery dissection triggered post-ischemic myocardial stunning and takotsubo syndrome: two different names for the same condition|journal=Cardiovascular Revascularization Medicine|volume=14|issue=2|year=2013|pages=109–112|issn=15538389|doi=10.1016/j.carrev.2012.11.005}}</ref><ref name="Y-HassanThemudo2017">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Themudo|first2=Raquel|last3=Maret|first3=Eva|title=Spontaneous coronary artery dissection and takotsubo syndrome: The chicken or the egg causality dilemma|journal=Catheterization and Cardiovascular Interventions|volume=89|issue=7|year=2017|pages=1215–1218|issn=15221946|doi=10.1002/ccd.26956}}</ref><ref name="Y-HassanBöhm2016">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Böhm|first2=Felix|title=The causal link between spontaneous coronary artery dissection and takotsubo syndrome: A case presented with both conditions|journal=International Journal of Cardiology|volume=203|year=2016|pages=828–831|issn=01675273|doi=10.1016/j.ijcard.2015.11.047}}</ref><ref name="YaltaUcar2016">{{cite journal|last1=Yalta|first1=Kenan|last2=Ucar|first2=Fatih|last3=Yilmaztepe|first3=Mustafa|last4=Ozkalayci|first4=Flora|title=Tako-tsubo cardiomyopathy and spontaneous coronary artery dissection: A subtle association with prognostic implications?|journal=International Journal of Cardiology|volume=202|year=2016|pages=174–176|issn=01675273|doi=10.1016/j.ijcard.2015.08.152}}</ref>  In the setting of TCM, vigorous contraction of the left ventricular base in conjunction with the adjacent akinetic/dyskinetic segments could form a prerequisite anatomic/functional substrate for the causation of SCAD.<ref name="Madias2015">{{cite journal|last1=Madias|first1=John E.|title=On a Plausible Association of Spontaneous Coronary Artery Dissection and Takotsubo Syndrome|journal=Canadian Journal of Cardiology|volume=31|issue=11|year=2015|pages=1410.e1|issn=0828282X|doi=10.1016/j.cjca.2015.07.720}}</ref>  The [[coronary dissection]] plane may develop as a result of excessive movement of the epicardial vessels and increased shear stress on the vessel wall at the hinge point between the hyperdynamic and [[dyskinetic]]/[[akinesia|akinetic]] [[myocardium]].  It has also been speculated that the [[coronary arteries]] traversing the anterior or anterolateral wall would be more vulnerable to dissection as this region marks the transition point of the hyperdynamic basal segment and the remaining [[dyskinetic]]/[[akinesia|akinetic]] [[left ventricular]] segments.  Another plausible mechanism is that elevated [[catecholamine]] concentrations in TCM may cause epicardial [[coronary]] [[vasoconstriction]] and/or [[coronary spasm|spasm]], which in turn leads to increased arterial shear stress and subsequent [[intimal]] tear or disruption of [[vasa vasorum]].<ref name="PellicciaKaski2017">{{cite journal|last1=Pelliccia|first1=Francesco|last2=Kaski|first2=Juan Carlos|last3=Crea|first3=Filippo|last4=Camici|first4=Paolo G.|title=Pathophysiology of Takotsubo Syndrome|journal=Circulation|volume=135|issue=24|year=2017|pages=2426–2441|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.116.027121}}</ref>  On the contrary, it is noteworthy that the post-ischemic [[myocardial stunning]] associated with SCAD could lead to TCM,<ref name="Y-HassanHenareh2013">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Henareh|first2=Loghman|title=Spontaneous coronary artery dissection triggered post-ischemic myocardial stunning and takotsubo syndrome: two different names for the same condition|journal=Cardiovascular Revascularization Medicine|volume=14|issue=2|year=2013|pages=109–112|issn=15538389|doi=10.1016/j.carrev.2012.11.005}}</ref> thus forming the “TCM begets SCAD, and SCAD begets TCM” vicious cycle.


==References==
==References==

Revision as of 16:19, 30 November 2017

Spontaneous Coronary Artery Dissection Microchapters

Home

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Spontaneous coronary artery dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Angiography

CT

MRI

Echocardiography

Other Imaging Findings

Other Diagnostic Studies

Treatment

Treatment Approach

Medical Therapy

Percutaneous Coronary Intervention

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Type 1

Type 2A

Type 2B

Type 3

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.

Synonyms and keywords: SCAD

Overview

The exact etiology of spontaneous coronary artery dissection remains elusive; however, fibromuscular dysplasia and takotsubo cardiomyopathy have been considered as the potential cause of spontaneous coronary artery dissection.

Causes

The exact etiology of spontaneous coronary artery dissection (SCAD) remains elusive and appears to be multifactorial. It has been postulated that the phenotypic expression of SCAD may occur as a result of predisposing factors compounded by precipitating stressors.[1] Among the conditions associated with the occurrence of SCAD, fibromuscular dysplasia (FMD) and takotsubo cardiomyopathy (TCM) have been postulated to have a causal relationship with SCAD.

Fibromuscular Dysplasia

FMD is a non-atherosclerotic vasculopathy characterized by thickening, fibrosis, and disarray of the arterial wall that primarily affects small and medium-sized vessels. The association between FMD and SCAD has been well described,[2][3][4][5] and the biological proof of causation has been supported by histopathologic reports.[6][7][8] It has been suggested that the presence of FMD may weaken the artery architecture and lead to aneurysm formation or coronary dissection.[9]

Takotsubo Cardiomyopathy

Both TCM and SCAD affect predominantly women and may be precipitated by emotional stress or strenuous exercise associated with sympathetic discharge. Numerous reports have described the concurrence of TCM and SCAD.[10][11][12][13][14] In the setting of TCM, vigorous contraction of the left ventricular base in conjunction with the adjacent akinetic/dyskinetic segments could form a prerequisite anatomic/functional substrate for the causation of SCAD.[15] The coronary dissection plane may develop as a result of excessive movement of the epicardial vessels and increased shear stress on the vessel wall at the hinge point between the hyperdynamic and dyskinetic/akinetic myocardium. It has also been speculated that the coronary arteries traversing the anterior or anterolateral wall would be more vulnerable to dissection as this region marks the transition point of the hyperdynamic basal segment and the remaining dyskinetic/akinetic left ventricular segments. Another plausible mechanism is that elevated catecholamine concentrations in TCM may cause epicardial coronary vasoconstriction and/or spasm, which in turn leads to increased arterial shear stress and subsequent intimal tear or disruption of vasa vasorum.[16] On the contrary, it is noteworthy that the post-ischemic myocardial stunning associated with SCAD could lead to TCM,[11] thus forming the “TCM begets SCAD, and SCAD begets TCM” vicious cycle.

References

  1. ↑ Saw, Jacqueline; Mancini, G.B. John; Humphries, Karin H. (2016). "Contemporary Review on Spontaneous Coronary Artery Dissection". Journal of the American College of Cardiology. 68 (3): 297–312. doi:10.1016/j.jacc.2016.05.034. ISSN 0735-1097.
  2. ↑ Saw, J.; Poulter, R.; Fung, A.; Wood, D.; Hamburger, J.; Buller, C. E. (2012). "Spontaneous Coronary Artery Dissection in Patients With Fibromuscular Dysplasia: A Case Series". Circulation: Cardiovascular Interventions. 5 (1): 134–137. doi:10.1161/CIRCINTERVENTIONS.111.966630. ISSN 1941-7640.
  3. ↑ 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.
  4. ↑ Toggweiler, S; Puck, M; Thalhammer, C; Manka, R; Wyss, M; Bilecen, D; Corti, R; Amann-Vesti, B; Lüscher, T; Wyss, C (2012). "Associated vascular lesions in patients with spontaneous coronary artery dissection". Swiss Medical Weekly. doi:10.4414/smw.2012.13538. ISSN 1424-7860.
  5. ↑ 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.
  6. ↑ Lie, J.T.; Berg, K.K. (1987). "Isolated fibromuscular dysplasia of the coronary arteries with spontaneous dissection and myocardial infarction". Human Pathology. 18 (6): 654–656. doi:10.1016/S0046-8177(87)80368-4. ISSN 0046-8177.
  7. ↑ Mather PJ, Hansen CL, Goldman B, Inniss S, Piña I, Norris R, Jeevanandam V, Bove AA (1994). "Postpartum multivessel coronary dissection". J. Heart Lung Transplant. 13 (3): 533–7. PMID 8061031.
  8. ↑ Brodsky, Sergey V.; Ramaswamy, Gita; Chander, Praveen; Braun, Alex (2007). "Ruptured Cerebral Aneurysm and Acute Coronary Artery Dissection in the Setting of Multivascular Fibromuscular Dysplasia". Angiology. 58 (6): 764–767. doi:10.1177/0003319707303645. ISSN 0003-3197.
  9. ↑ Olin, J. W.; Gornik, H. L.; Bacharach, J. M.; Biller, J.; Fine, L. J.; Gray, B. H.; Gray, W. A.; Gupta, R.; Hamburg, N. M.; Katzen, B. T.; Lookstein, R. A.; Lumsden, A. B.; Newburger, J. W.; Rundek, T.; Sperati, C. J.; Stanley, J. C. (2014). "Fibromuscular Dysplasia: State of the Science and Critical Unanswered Questions: A Scientific Statement From the American Heart Association". Circulation. 129 (9): 1048–1078. doi:10.1161/01.cir.0000442577.96802.8c. ISSN 0009-7322.
  10. ↑ Chou, Annie Y.; Sedlak, Tara; Aymong, Eve; Sheth, Tej; Starovoytov, Andrew; Humphries, Karin H.; Mancini, G.B. John; Saw, Jacqueline (2015). "Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Cardiomyopathy: A Case Series". Canadian Journal of Cardiology. 31 (8): 1073.e5–1073.e8. doi:10.1016/j.cjca.2015.03.018. ISSN 0828-282X.
  11. ↑ 11.0 11.1 Y-Hassan, Shams; Henareh, Loghman (2013). "Spontaneous coronary artery dissection triggered post-ischemic myocardial stunning and takotsubo syndrome: two different names for the same condition". Cardiovascular Revascularization Medicine. 14 (2): 109–112. doi:10.1016/j.carrev.2012.11.005. ISSN 1553-8389.
  12. ↑ Y-Hassan, Shams; Themudo, Raquel; Maret, Eva (2017). "Spontaneous coronary artery dissection and takotsubo syndrome: The chicken or the egg causality dilemma". Catheterization and Cardiovascular Interventions. 89 (7): 1215–1218. doi:10.1002/ccd.26956. ISSN 1522-1946.
  13. ↑ Y-Hassan, Shams; Böhm, Felix (2016). "The causal link between spontaneous coronary artery dissection and takotsubo syndrome: A case presented with both conditions". International Journal of Cardiology. 203: 828–831. doi:10.1016/j.ijcard.2015.11.047. ISSN 0167-5273.
  14. ↑ Yalta, Kenan; Ucar, Fatih; Yilmaztepe, Mustafa; Ozkalayci, Flora (2016). "Tako-tsubo cardiomyopathy and spontaneous coronary artery dissection: A subtle association with prognostic implications?". International Journal of Cardiology. 202: 174–176. doi:10.1016/j.ijcard.2015.08.152. ISSN 0167-5273.
  15. ↑ Madias, John E. (2015). "On a Plausible Association of Spontaneous Coronary Artery Dissection and Takotsubo Syndrome". Canadian Journal of Cardiology. 31 (11): 1410.e1. doi:10.1016/j.cjca.2015.07.720. ISSN 0828-282X.
  16. ↑ Pelliccia, Francesco; Kaski, Juan Carlos; Crea, Filippo; Camici, Paolo G. (2017). "Pathophysiology of Takotsubo Syndrome". Circulation. 135 (24): 2426–2441. doi:10.1161/CIRCULATIONAHA.116.027121. ISSN 0009-7322.
Retrieved from "https://www.wikidoc.org/index.php?title=Spontaneous_coronary_artery_dissection_causes&oldid=1399463"