Coronary artery dissection

A spontaneous coronary artery dissection (also known as 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 data indicate this figure may be closer to 18%.^[2]

SCAD (Spontaneous Coronary Artery Dissection) is a primary cause of MI in young, fit, healthy women (and some men) with no obvious risk factors. These can often occur during late pregnancy, postpartum and peri-menopausal periods.

Signs and symptoms

The symptoms are often very similar to those of myocardial infarction (heart attack), with the most common being persistent chest pain.^[3]

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, recent delivery of a baby, fibromuscular dysplasia and connective-tissue disorders (e.g., Marfan syndrome and Ehlers-Danlos syndrome) may occasionally result in SCAD.^[4] There is also a possibility that vigorous exercise can be a trigger. However, many cases have no obvious cause.^[5][6]

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.^[7][8]

Diagnosis

A selective coronary angiogram is the most common method to diagnose the condition, although it is sometimes not recognised until after death.^[9] Intravascular ultrasound (IVUS) is also used as it is able to more easily differentiate the condition from atherosclerotic disease.^[10]

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.^[11] Drug-eluting stents and thrombolytic drug therapy are less invasive options for less severe cases.^[10]

Epidemiology

Eighty percent of cases are in women. ^[12]

See also

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

References

External links

• "Spontaneous Coronary Artery Dissection Postpartum"
• "Spontaneous-Coronary-Artery-Dissection-Case-Series-and-Review"
• www.beatscad.org.uk
• Leicester Cardiovascular Biomedical Research Unit Spontaneous Coronary Artery Dissection research project
• British Heart Foundation Spontaneous Coronary Artery Dissection information sheet