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      Idiopathic, Serial Coronary Vessels Dissection in a Young Woman with Psychological Stress: A Case Report and Review of the Literature

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          Abstract

          Spontaneous coronary artery dissection (SCAD) is a very rare disease, associated with high mortality rate, whose etiology and pathogenesis are poorly understood. Its sporadic nature and the varied angiographic extent make firm recommendations regarding revascularization impossible. The case described is that of a young, otherwise healthy woman, without a known underlying condition which may lead to SCAD, but with a history of intense psychological stress. We managed the patient with a conservative approach based on watchful waiting, medical therapy, and plain old balloon angioplasty (POBA) with low inflation atmospheres.

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          Clinical course and long-term prognosis of spontaneous coronary artery dissection.

          E Silverman, S Kinsella, S DeMaio (1989)
          Spontaneous coronary artery dissection is rare. In comparison with the usual myocardial infarction population, it occurs in relatively young people with a striking predilection for women. Of 83 cases that have been described, 62 were diagnosed at autopsy and 21 were found antemortem. A series of 11 patients with the antemortem diagnosis of spontaneous coronary artery dissection is reported and follow-up is provided for 16 of the 21 previously reported cases. Of the 62 autopsy cases, 10 (16%) were men (mean age 47) and 52 (84%) were women (mean age 40). Dissection of the left anterior descending coronary artery predominated in this group of patients, occurring in 80% of men and 65% of women. Of the 32 cases diagnosed antemortem, 15 (47%) were men (mean age 46) and 17 (53%) were women (mean age 38). Men were found to have dissection predominantly of the right coronary artery (73%). Women were found to have dissection predominantly of the left coronary artery system (88%). The etiology of spontaneous coronary artery dissection remains unclear. The 3 groups that can be identified are those associated with atherosclerotic coronary artery disease, those in the postpartum period and those found to be idiopathic. Of the 94 known cases, 69 (73%) occurred in women; 21 (31%) of these were associated with the postpartum state. The prognosis of patients surviving the initial event is good, with an 82% survival rate (follow-up: range 1.5 to 144 months, mean 38). The indications for medical or surgical treatment are presented. Spontaneous coronary artery dissection should be considered in the differential diagnosis of any young person sustaining an acute myocardial infarction, especially women in the postpartum state.
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            Spontaneous coronary dissection: a cluster of cases with this rare finding.

            V Aharonian, Peter Jørgensen, P Mahrer … (1994)
            Spontaneous coronary dissection is a rare entity. It has been reported to be usually fatal, with greater than an 80% mortality rate. From April 1990 through March 1993, 10 patients had spontaneous coronary dissection. This is a significant increase in the incidence of this diagnosis, with only one prior case at this institution in 1983 (p < 0.001). All of the patients survived. Of the 10 patients, eight were women, and seven of those were premenopausal. Only one was post partum. Acute myocardial infarction was the presenting condition in nine patients. Three patients had spontaneous dissections involving two arteries. Only one patient had associated atherosclerotic coronary artery disease. Surgery was required for continued symptoms in three patients, with difficulty grafting the dissected artery in two. Nine patients have no symptoms, and one has class II angina. With aggressive medical therapy the prognosis of patients with spontaneous coronary dissection may not be as dismal as previously reported.
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              Idiopathic spontaneous coronary artery dissection: incidence, diagnosis and treatment.

              W Angehrn, Micha Maeder, Hans Rickli … (2005)
              Less is known about characteristics, treatment and follow-up of patients with spontaneous coronary artery dissection (SCAD) without associated pregnancy or underlying atherosclerosis. We reviewed 5054 consecutive coronary angiographies for SCAD in patients without atherosclerosis or associated pregnancy and performed follow-up angiography in eligible patients. SCAD were assessed in five patients (mean age 44 +/- 8.7 years). Interestingly, all were premenopausal women. Three had no cardiovascular risk factors, whereas two were previous smokers and one had slightly elevated cholesterol levels. Clinical presentation was acute myocardial infarction in four cases and unstable angina pectoris in one of them. Dissection was localized in the left anterior descending artery (LAD) in three cases and in the first marginal branch of the left circumflex artery in two cases. Three patients were treated conservatively with antithrombotic therapy and beta-blocker, whereas in one patient rescue-PCI with stenting of the ostium of the LAD was performed after failed thrombolysis. The fifth woman with dissected proximal LAD underwent CABG. Follow-up angiographies after 5.9 +/- 4.4 months showed complete angiographic resolution of the dissection in the medically treated patients and a perfect angiographic result of the stented LAD. All patients were free of symptoms after a mean follow-up of 13 +/- 10 months. Idiopathic SCAD is a rare cause of acute coronary syndrome in premenopausal women. In case of single vessel dissection and normal blood flow of the dissected vessel, medical treatment with aspirin, clopidogrel and beta-blockade leads to complete angiographic resolution within a few months.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Report Vasc Med
                Journal ID (iso-abbrev): Case Report Vasc Med
                Journal ID (publisher-id): CRIM.VASMED
                Title: Case Reports in Vascular Medicine
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-6986
                ISSN (Electronic): 2090-6994
                Publication date (Print): 2012
                Publication date (Electronic): 23 October 2012
                Volume: 2012
                Electronic Location Identifier: 498465
                Affiliations
                Interventional Cardiology Unit, Santa Maria University Hospital, Via Tristano Di Joannuccio 1, 05100 Terni, Italy
                Author notes

                Academic Editors: A. Iyisoy and C. A. Staton

                Article
                DOI: 10.1155/2012/498465
                PMC ID: 3485898
                PubMed ID: 23133786
                SO-VID: 112a2ade-fed4-4880-98d9-db9fc8c5da2c
                Copyright © Copyright © 2012 Alessio Arrivi et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 22 August 2012
                Date accepted : 2 October 2012
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine

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