Coronary artery dissection

Coronary artery dissection (also known as spontaneous coronary artery dissection or SCAD) is a rare cause of acute coronary syndrome especially in young patients who are otherwise healthy.

Coronary artery dissection occurs mainly in young, otherwise health patients especially in females in whom 84% of cases occur 1. One study found the prevalence of coronary artery dissection in patients undergoing coronary angiography to be 0.1% with a mean age of 44 years 2.

The features of coronary artery dissection depends on the severity and extent of the dissection with presentations ranging from those of acute coronary syndrome to sudden death 3.

Coronary artery dissection is believed to be due to an intramural hematoma in the wall of a coronary vessel creating a false lumen which then causes occlusion of the true lumen. The effect of this is reduced blood flow and consequently ischemia in the cardiac muscle 3. The majority of cases are idiopathic although it has been associated with pregnancy or being postpartum (one-third of all cases), atherosclerosis, connective disease (eg. Ehlers-Danlos syndrome type IV, Marfan's syndrome) and other conditions and toxins (eg. SLE, cocaine abuse) 3.

Most of the literature describes coronary artery dissection as being diagnosed on coronary angiogram 3. However, it has also been diagnosed on CT coronary angiography in the past, resolution of the dissection has also been assessed using CT coronary angiography 4. The role of other imaging modalities is primarily to exclude other causes other chest pain (eg. aortic dissection, pulmonary embolism). If an underlying condition is suspected or diagnosed (eg. Marfan syndrome) imaging may be needed to exclude other sites of aneurysm.

The survival from coronary artery dissection in one study was quoted to be up to 82% in long term follow up 1. Treatment may be performed by stenting and more rarely surgery, but medical management only has also successfully been described 5,6.

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Article information

rID: 59407
System: Vascular, Cardiac
Tag: cases
Synonyms or Alternate Spellings:
  • spontaneous coronary artery dissection
  • SCAD

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