Spontaneous coronary artery dissection risk factors

Spontaneous Coronary Artery Dissection Microchapters
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Overview
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Differentiating Spontaneous coronary artery dissection from other Diseases
Epidemiology and Demographics
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Natural History, Complications and Prognosis
Diagnosis
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History and Symptoms
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Cost-Effectiveness of Therapy
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Case Studies
Type 1 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Type 2A Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Type 2B Case 1 Case 2 Case 3 Case 4 Type 3 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6

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 risk factors for spontaneous coronary artery dissection include predisposing factors (e.g., vasculopathy, pregnancy, connective tissue disorder, systemic inflammation) and precipitating stressors (e.g., strenuous exercise, emotional stress, recreational drugs).

Risk Factors

• The phenotypic manifestation of spontaneous coronary artery dissection (SCAD) may occur as a result of predisposing factors compounded by precipitating stressors. *The presence of either predisposing or precipitating factors increases the risk of developing a dissection.
• The potential risk factors for SCAD include:

Risk factor	Condition
Predisposing factors	Fibromuscular dysplasia Pregnancy-related: antepartum, early post-partum, late post-partum, very late post-partum Recurrent pregnancies: multiparity or multigravida Connective tissue disorder: Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome type 4, neurofibromatosis type I, cystic medial necrosis, alpha-1 antitrypsin deficiency, polycystic kidney disease, lysyl oxidase deficiency, Alport syndrome, pseudoxanthoma elasticum Systemic inflammatory disease: systemic lupus erythematosus, Crohn's disease, ulcerative colitis, polyarteritis nodosa, sarcoidosis, Churg-Strauss syndrome, Wegener's granulomatosis, rheumatoid arthritis, Kawasaki disease, giant cell arteritis, celiac disease, Takayasu arteritis, cryoglobulinemia, Behçet's disease Other disease: polycythemia vera, hypothyroidism Hormonal therapy: oral contraceptive, estrogen, progesterone, beta-HCG, testosterone, corticosteroids, clomiphene, polycystic ovarian syndrome Takotsubo cardiomyopathy Coronary artery spasm Atherosclerosis Idiopathic
Precipitating stressors	Intense exercises: isometric exercise, aerobic exercise Emotional stress Labor and delivery Valsava-type activities: retching, vomiting, bowel movement, coughing Recreational drugs: cocaine, amphetamines, methamphetamines Hormonal therapy: beta-HCG, corticosteroids Sleep deprivation Drugs: calcineurin inhibitors, 5-FU, fenfluramine, corticosteroids, methylphenidate, ergotamine, sumatriptan, hypersensitivity reactions, dobutamine

Features that raise the index of suspicion for SCAD include:

• Myocardial infarction in young women (age ≤50)
• Absence of traditional cardiovascular risk factors
• Little or no evidence of coronary atherosclerosis
• Peripartum state
• History of fibromuscular dysplasia
• History of connective tissue disorder or systemic inflammatory disorder:

• Marfan's syndrome
• Type 4 Ehlers-Danlos syndrome
• Loeys-Dietz syndrome
• Cystic medial necrosis
• Systemic lupus erythematosus
• Crohn's disease
• Ulcerative colitis
• Polyarteritis nodosa
• Sarcoidosis
• Churg-Strauss syndrome
• Wegener's granulomatosis
• Rheumatoid arthritis
• Giant cell arteritis