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.
- ^ Robert Slight; Ali Asgar Behranwala; Onyekwelu Nzewi; Rajesh Sivaprakasam; Edward Brackenbury; Pankaj Mankad (2003) "Spontaneous coronary artery dissection: a report of two cases occurring during menstruation" New Zealand Medical Journal]
- ^ Umman, Sabahattin; Olcay, Ayhan; Sezer, Murat; Erdogan, Dogan (2006) "Exercise-induced coronary artery dissection treated with an anticoagulant and antiaggregants" The Anatolian Journal of Cardiology
- ^ Monika Juszczyk MD; Thomas Marnejon; David A. Hoffman; (2004) "Spontaneous Coronary Artery Dissection Postpartum" Invasive Cardiology
- ^ a b Andrew Boyle; Michael Chan; Joud Dib; Jon Resar (2006) "Catheter-Induced Coronary Artery Dissection: Risk Factors, Prevention and Management" Inavasive Cardiology
- ^ "Spontaneous Coronary Artery Dissection Postpartum"
- ^ Dhawan R, Singh G, Fesniak H. (2002) "Spontaneous coronary artery dissection: the clinical spectrum". Angiology
- ^ Mark V. Sherrid; Jennifer Mieres; Allen Mogtader; Naresh Menezes; Gregory Steinberg (1995) "Onset During Exercise of Spontaneous Coronary Artery Dissection and Sudden Death. Occurrence in a Trained Athlete: Case Report and Review of Prior Cases" Chest
- ^ Virmani R, Forman MB, Rabinowitz M, McAllister HA (1984) "Coronary artery dissections" Cardiol Clinics
- ^ Kamineni R, Sadhu A, Alpert JS. (2002) "Spontaneous coronary artery dissection: Report of two cases and 50-year review of the literature" Cardiol Rev
- ^ C. Basso, G. L. Morgagni, G. Thiene (1996) "Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death" BMJ
- ^ a b Intravascular Ultrasound Imaging in the Diagnosis and Treatment: The Future: IVUS-Guided DES Implantation?
- ^ MedHelp:Coronary artery dissection treatment
Cardiovascular disease: heart disease · Circulatory system pathology (I00–I52, 390–429) IschaemicActive ischemia LayersValves Conduction/
arrhythmiaPremature contractionWolff-Parkinson-White · Lown-Ganong-LevineFlutter/fibrillationPacemakerOther/ungrouped
Wikimedia Foundation. 2010.
Look at other dictionaries:
Coronary artery aneurysm — Classification and external resources ICD 10 I25.4 ICD 9 414.11 … Wikipedia
Coronary artery disease — Classification and external resources Micrograph of a coronary artery with the most common form of coronary artery disease (atherosclerosis) and marked luminal narrowing. Masson s trichrome … Wikipedia
Vertebral artery dissection — Classification and external resources … Wikipedia
Carotid artery dissection — Classification and external resources ICD 9 443.21 … Wikipedia
Dissection (medical) — Classification and external resources Aortic dissection ICD 9 441.0 … Wikipedia
Coronary disease — Classification and external resources ICD 9 414.00 MeSH D003327 Coronary disease (or … Wikipedia
Coronary vasospasm — Classification and external resources ICD 9 413.1 DiseasesDB 13727 … Wikipedia
Coronary thrombosis — Classification and external resources ICD 10 I24.0 ICD 9 414.8 … Wikipedia
Aortic dissection — Classification and external resources Dissection of the aorta descendens (3), which starts from the left subclavian artery, reaching to the abdominal aorta (4). Aorta ascendens (1) and aortic arch (2) are not involved … Wikipedia
Percutaneous coronary intervention — Intervention A coronary angiogram (an X ray with radio opaque contrast in the coronary arteries) that shows the left coronary circulation. The distal left main coronary artery (LMCA) is in the left upper quadrant of the image. Its main branches… … Wikipedia