Spontaneous coronary artery dissection causes: Difference between revisions

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__NOTOC__
__NOTOC__
{{Spontaneous coronary artery dissection}}
{{Spontaneous coronary artery dissection}}
{{CMG}}; {{AE}}{{NRM}} {{AKK}}
{{CMG}}; {{AE}}{{Sara.Zand}} {{NRM}} {{AKK}}


{{SK}} SCAD
{{SK}} SCAD
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==Overview==
==Overview==


The exact etiology of spontaneous coronary artery dissection remains elusive; however, [[fibromuscular dysplasia]] and [[takotsubo cardiomyopathy]] have been considered as the potential cause of spontaneous coronary artery dissection.
The exact etiology of [[spontaneous coronary artery dissection]] remains elusive; however, [[fibromuscular dysplasia]] and [[takotsubo cardiomyopathy]] have been considered as the potential cause of [[spontaneous coronary artery dissection]]. The underlying causes associated with [[SCAD]] include [[emotional stress]], physical [[stress]] such as extreme [[valsalva maneuver]], [[retching]], [[vomiting]], [[coughing]], [[isometric exercise]], history of using stimulant [[medications]] or [[illicit drugs]], [[pregnancy]], and [[connective tissue disorders]].


==Causes==
==Causes==
Common causes associated with [[spontaneous coronary artery dissection (SCAD)]] include:
Common causes associated with [[spontaneous coronary artery dissection]] ([[SCAD]]) include:<ref name="SawMancini2016">{{cite journal|last1=Saw|first1=Jacqueline|last2=Mancini|first2=G.B. John|last3=Humphries|first3=Karin H.|title=Contemporary Review on Spontaneous Coronary Artery Dissection|journal=Journal of the American College of Cardiology|volume=68|issue=3|year=2016|pages=297–312|issn=07351097|doi=10.1016/j.jacc.2016.05.034}}</ref><ref name="pmid24227590">{{cite journal| author=Saw J| title=Coronary angiogram classification of spontaneous coronary artery dissection. | journal=Catheter Cardiovasc Interv | year= 2014 | volume= 84 | issue= 7 | pages= 1115-22 | pmid=24227590 | doi=10.1002/ccd.25293 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24227590  }}</ref>
 
* [[Emotional stress]]
* [[Emotional stress]]
* Physical [[stress]] such as extreme [[Valsalva maneuver]], [[retching]], [[vomiting]], [[coughing]], [[isometric exercise]]
* Physical [[stress]] such as extreme [[valsalva maneuver]], [[retching]], [[vomiting]], [[coughing]], [[isometric exercise]]
* Using stimulant [[medications]], [[illicit drugs]]
* Using stimulant [[medications]], [[illicit drugs]]
* [[Hormonal]] triggers such as [[pregnancy]]
* [[Hormonal]] triggers such as [[pregnancy]]
* [[Inflammatory disorders]] such as [[systemic lupus erythematosus]], [[sarcoidosis]], [[inflammatory bowel disease]], [[celiac disease]]
* [[Inflammatory disorders]] such as [[systemic lupus erythematosus]], [[sarcoidosis]], [[Crohn's disease]], [[Ulcerative colitis]] , [[celiac disease]], [[fibromuscular dysplasia]] (FMD)[[takotsubo cardiomyopathy]] (TCM)
 
* [[Connective tissue disorders]] such as vascular [[Ehlers–Danlos syndrome]], [[marfan’s syndrome]], [[Loeys–Dietz syndrome]], [[cystic medial necrosis]], [[systemic lupus erythematosus]], [[polyarteritis nodosa]], [[sarcoidosis]], [[churg-Strauss syndrome]], [[wegener's granulomatosis]], [[rheumatoid arthritis]], [[Temporal arteritis|giant cell arthritis]]
 
 
 
 
 
 
 
 
 
 
 
 
It has been postulated that the phenotypic expression of SCAD may occur as a result of predisposing factors compounded by precipitating stressors.<ref name="SawMancini2016">{{cite journal|last1=Saw|first1=Jacqueline|last2=Mancini|first2=G.B. John|last3=Humphries|first3=Karin H.|title=Contemporary Review on Spontaneous Coronary Artery Dissection|journal=Journal of the American College of Cardiology|volume=68|issue=3|year=2016|pages=297–312|issn=07351097|doi=10.1016/j.jacc.2016.05.034}}</ref>  Among the conditions associated with the occurrence of SCAD, [[fibromuscular dysplasia]] (FMD) and [[takotsubo cardiomyopathy]] (TCM) have been postulated to have a causal relationship with SCAD.


===Fibromuscular Dysplasia===
===Fibromuscular Dysplasia===


FMD is a non-[[atherosclerotic]] [[vasculopathy]] characterized by thickening, [[fibrosis]], and disarray of the arterial wall that primarily affects small and medium-sized vessels. The association between FMD and SCAD has been well described,<ref name="SawPoulter2012">{{cite journal|last1=Saw|first1=J.|last2=Poulter|first2=R.|last3=Fung|first3=A.|last4=Wood|first4=D.|last5=Hamburger|first5=J.|last6=Buller|first6=C. E.|title=Spontaneous Coronary Artery Dissection in Patients With Fibromuscular Dysplasia: A Case Series|journal=Circulation: Cardiovascular Interventions|volume=5|issue=1|year=2012|pages=134–137|issn=1941-7640|doi=10.1161/CIRCINTERVENTIONS.111.966630}}</ref><ref name="SawRicci2013">{{cite journal|last1=Saw|first1=Jacqueline|last2=Ricci|first2=Donald|last3=Starovoytov|first3=Andrew|last4=Fox|first4=Rebecca|last5=Buller|first5=Christopher E.|title=Spontaneous Coronary Artery Dissection|journal=JACC: Cardiovascular Interventions|volume=6|issue=1|year=2013|pages=44–52|issn=19368798|doi=10.1016/j.jcin.2012.08.017}}</ref><ref name="ToggweilerPuck2012">{{cite journal|last1=Toggweiler|first1=S|last2=Puck|first2=M|last3=Thalhammer|first3=C|last4=Manka|first4=R|last5=Wyss|first5=M|last6=Bilecen|first6=D|last7=Corti|first7=R|last8=Amann-Vesti|first8=B|last9=Lüscher|first9=T|last10=Wyss|first10=C|title=Associated vascular lesions in patients with spontaneous coronary artery dissection|journal=Swiss Medical Weekly|year=2012|issn=1424-7860|doi=10.4414/smw.2012.13538}}</ref><ref name="SawAymong2014">{{cite journal|last1=Saw|first1=J.|last2=Aymong|first2=E.|last3=Sedlak|first3=T.|last4=Buller|first4=C. E.|last5=Starovoytov|first5=A.|last6=Ricci|first6=D.|last7=Robinson|first7=S.|last8=Vuurmans|first8=T.|last9=Gao|first9=M.|last10=Humphries|first10=K.|last11=Mancini|first11=G. B. J.|title=Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes|journal=Circulation: Cardiovascular Interventions|volume=7|issue=5|year=2014|pages=645–655|issn=1941-7640|doi=10.1161/CIRCINTERVENTIONS.114.001760}}</ref> and the biological proof of causation has been supported by histopathologic reports.<ref name="LieBerg1987">{{cite journal|last1=Lie|first1=J.T.|last2=Berg|first2=K.K.|title=Isolated fibromuscular dysplasia of the coronary arteries with spontaneous dissection and myocardial infarction|journal=Human Pathology|volume=18|issue=6|year=1987|pages=654–656|issn=00468177|doi=10.1016/S0046-8177(87)80368-4}}</ref><ref>{{cite journal |vauthors=Mather PJ, Hansen CL, Goldman B, Inniss S, Piña I, Norris R, Jeevanandam V, Bove AA |title=Postpartum multivessel coronary dissection |journal=J. Heart Lung Transplant. |volume=13 |issue=3 |pages=533–7 |year=1994 |pmid=8061031 |doi= |url=}}</ref><ref name="BrodskyRamaswamy2007">{{cite journal|last1=Brodsky|first1=Sergey V.|last2=Ramaswamy|first2=Gita|last3=Chander|first3=Praveen|last4=Braun|first4=Alex|title=Ruptured Cerebral Aneurysm and Acute Coronary Artery Dissection in the Setting of Multivascular Fibromuscular Dysplasia|journal=Angiology|volume=58|issue=6|year=2007|pages=764–767|issn=0003-3197|doi=10.1177/0003319707303645}}</ref> It has been suggested that the presence of FMD may weaken the artery architecture and lead to [[aneurysm|aneurysm formation]] or [[coronary dissection]].<ref name="OlinGornik2014">{{cite journal|last1=Olin|first1=J. W.|last2=Gornik|first2=H. L.|last3=Bacharach|first3=J. M.|last4=Biller|first4=J.|last5=Fine|first5=L. J.|last6=Gray|first6=B. H.|last7=Gray|first7=W. A.|last8=Gupta|first8=R.|last9=Hamburg|first9=N. M.|last10=Katzen|first10=B. T.|last11=Lookstein|first11=R. A.|last12=Lumsden|first12=A. B.|last13=Newburger|first13=J. W.|last14=Rundek|first14=T.|last15=Sperati|first15=C. J.|last16=Stanley|first16=J. C.|title=Fibromuscular Dysplasia: State of the Science and Critical Unanswered Questions: A Scientific Statement From the American Heart Association|journal=Circulation|volume=129|issue=9|year=2014|pages=1048–1078|issn=0009-7322|doi=10.1161/01.cir.0000442577.96802.8c}}</ref>
* [[FMD]] is a non-[[atherosclerotic]] [[vasculopathy]] characterized by thickening, [[fibrosis]], and disarray of the [[arterial]] wall that primarily affects small and medium-sized [[vessels]].  
 
* The association between [[FMD]] and [[SCAD]] has been well described,<ref name="SawPoulter2012">{{cite journal|last1=Saw|first1=J.|last2=Poulter|first2=R.|last3=Fung|first3=A.|last4=Wood|first4=D.|last5=Hamburger|first5=J.|last6=Buller|first6=C. E.|title=Spontaneous Coronary Artery Dissection in Patients With Fibromuscular Dysplasia: A Case Series|journal=Circulation: Cardiovascular Interventions|volume=5|issue=1|year=2012|pages=134–137|issn=1941-7640|doi=10.1161/CIRCINTERVENTIONS.111.966630}}</ref><ref name="SawRicci2013">{{cite journal|last1=Saw|first1=Jacqueline|last2=Ricci|first2=Donald|last3=Starovoytov|first3=Andrew|last4=Fox|first4=Rebecca|last5=Buller|first5=Christopher E.|title=Spontaneous Coronary Artery Dissection|journal=JACC: Cardiovascular Interventions|volume=6|issue=1|year=2013|pages=44–52|issn=19368798|doi=10.1016/j.jcin.2012.08.017}}</ref><ref name="ToggweilerPuck2012">{{cite journal|last1=Toggweiler|first1=S|last2=Puck|first2=M|last3=Thalhammer|first3=C|last4=Manka|first4=R|last5=Wyss|first5=M|last6=Bilecen|first6=D|last7=Corti|first7=R|last8=Amann-Vesti|first8=B|last9=Lüscher|first9=T|last10=Wyss|first10=C|title=Associated vascular lesions in patients with spontaneous coronary artery dissection|journal=Swiss Medical Weekly|year=2012|issn=1424-7860|doi=10.4414/smw.2012.13538}}</ref><ref name="SawAymong2014">{{cite journal|last1=Saw|first1=J.|last2=Aymong|first2=E.|last3=Sedlak|first3=T.|last4=Buller|first4=C. E.|last5=Starovoytov|first5=A.|last6=Ricci|first6=D.|last7=Robinson|first7=S.|last8=Vuurmans|first8=T.|last9=Gao|first9=M.|last10=Humphries|first10=K.|last11=Mancini|first11=G. B. J.|title=Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes|journal=Circulation: Cardiovascular Interventions|volume=7|issue=5|year=2014|pages=645–655|issn=1941-7640|doi=10.1161/CIRCINTERVENTIONS.114.001760}}</ref>  
===Takotsubo Cardiomyopathy===
*The biological proof of causation has been supported by [[histopathologic]] reports.<ref name="LieBerg1987">{{cite journal|last1=Lie|first1=J.T.|last2=Berg|first2=K.K.|title=Isolated fibromuscular dysplasia of the coronary arteries with spontaneous dissection and myocardial infarction|journal=Human Pathology|volume=18|issue=6|year=1987|pages=654–656|issn=00468177|doi=10.1016/S0046-8177(87)80368-4}}</ref><ref>{{cite journal |vauthors=Mather PJ, Hansen CL, Goldman B, Inniss S, Piña I, Norris R, Jeevanandam V, Bove AA |title=Postpartum multivessel coronary dissection |journal=J. Heart Lung Transplant. |volume=13 |issue=3 |pages=533–7 |year=1994 |pmid=8061031 |doi= |url=}}</ref><ref name="BrodskyRamaswamy2007">{{cite journal|last1=Brodsky|first1=Sergey V.|last2=Ramaswamy|first2=Gita|last3=Chander|first3=Praveen|last4=Braun|first4=Alex|title=Ruptured Cerebral Aneurysm and Acute Coronary Artery Dissection in the Setting of Multivascular Fibromuscular Dysplasia|journal=Angiology|volume=58|issue=6|year=2007|pages=764–767|issn=0003-3197|doi=10.1177/0003319707303645}}</ref>  
 
* The presence of [[FMD]] may weaken the [[artery]] architecture and lead to [[aneurysm|aneurysm formation]] or [[coronary dissection]].<ref name="OlinGornik2014">{{cite journal|last1=Olin|first1=J. W.|last2=Gornik|first2=H. L.|last3=Bacharach|first3=J. M.|last4=Biller|first4=J.|last5=Fine|first5=L. J.|last6=Gray|first6=B. H.|last7=Gray|first7=W. A.|last8=Gupta|first8=R.|last9=Hamburg|first9=N. M.|last10=Katzen|first10=B. T.|last11=Lookstein|first11=R. A.|last12=Lumsden|first12=A. B.|last13=Newburger|first13=J. W.|last14=Rundek|first14=T.|last15=Sperati|first15=C. J.|last16=Stanley|first16=J. C.|title=Fibromuscular Dysplasia: State of the Science and Critical Unanswered Questions: A Scientific Statement From the American Heart Association|journal=Circulation|volume=129|issue=9|year=2014|pages=1048–1078|issn=0009-7322|doi=10.1161/01.cir.0000442577.96802.8c}}</ref>
Both TCM and SCAD affect predominantly women and may be precipitated by [[emotional stress]] or [[exercise|strenuous exercise]] associated with [[sympathetic nerve|sympathetic]] discharge.  Numerous reports have described the concurrence of TCM and SCAD.<ref name="ChouSedlak2015">{{cite journal|last1=Chou|first1=Annie Y.|last2=Sedlak|first2=Tara|last3=Aymong|first3=Eve|last4=Sheth|first4=Tej|last5=Starovoytov|first5=Andrew|last6=Humphries|first6=Karin H.|last7=Mancini|first7=G.B. John|last8=Saw|first8=Jacqueline|title=Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Cardiomyopathy: A Case Series|journal=Canadian Journal of Cardiology|volume=31|issue=8|year=2015|pages=1073.e5–1073.e8|issn=0828282X|doi=10.1016/j.cjca.2015.03.018}}</ref><ref name="Y-HassanHenareh2013">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Henareh|first2=Loghman|title=Spontaneous coronary artery dissection triggered post-ischemic myocardial stunning and takotsubo syndrome: two different names for the same condition|journal=Cardiovascular Revascularization Medicine|volume=14|issue=2|year=2013|pages=109–112|issn=15538389|doi=10.1016/j.carrev.2012.11.005}}</ref><ref name="Y-HassanThemudo2017">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Themudo|first2=Raquel|last3=Maret|first3=Eva|title=Spontaneous coronary artery dissection and takotsubo syndrome: The chicken or the egg causality dilemma|journal=Catheterization and Cardiovascular Interventions|volume=89|issue=7|year=2017|pages=1215–1218|issn=15221946|doi=10.1002/ccd.26956}}</ref><ref name="Y-HassanBöhm2016">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Böhm|first2=Felix|title=The causal link between spontaneous coronary artery dissection and takotsubo syndrome: A case presented with both conditions|journal=International Journal of Cardiology|volume=203|year=2016|pages=828–831|issn=01675273|doi=10.1016/j.ijcard.2015.11.047}}</ref><ref name="YaltaUcar2016">{{cite journal|last1=Yalta|first1=Kenan|last2=Ucar|first2=Fatih|last3=Yilmaztepe|first3=Mustafa|last4=Ozkalayci|first4=Flora|title=Tako-tsubo cardiomyopathy and spontaneous coronary artery dissection: A subtle association with prognostic implications?|journal=International Journal of Cardiology|volume=202|year=2016|pages=174–176|issn=01675273|doi=10.1016/j.ijcard.2015.08.152}}</ref>  In the setting of TCM, vigorous contraction of the left ventricular base in conjunction with the adjacent akinetic/dyskinetic segments could form a prerequisite anatomic/functional substrate for the causation of SCAD.<ref name="Madias2015">{{cite journal|last1=Madias|first1=John E.|title=On a Plausible Association of Spontaneous Coronary Artery Dissection and Takotsubo Syndrome|journal=Canadian Journal of Cardiology|volume=31|issue=11|year=2015|pages=1410.e1|issn=0828282X|doi=10.1016/j.cjca.2015.07.720}}</ref>  The [[coronary dissection]] plane may develop as a result of excessive movement of the epicardial vessels and increased shear stress on the vessel wall at the hinge point between the hyperdynamic and [[dyskinetic]]/[[akinesia|akinetic]] [[myocardium]].<ref name="Madias2017">{{cite journal|last1=Madias|first1=John E.|title=A Possible Amphidromic Relation Between Spontaneous Coronary Artery Dissection and Takotsubo Syndrome|journal=The American Journal of Cardiology|volume=120|issue=3|year=2017|pages=e69|issn=00029149|doi=10.1016/j.amjcard.2016.10.008}}</ref>  It has also been speculated that the [[coronary arteries]] traversing the anterior or anterolateral wall would be more vulnerable to dissection as this region marks the transition point of the hyperdynamic basal segment and the remaining [[dyskinetic]]/[[akinesia|akinetic]] [[left ventricular]] segments.  Another plausible mechanism is that elevated [[catecholamine]] concentrations in TCM may cause epicardial [[coronary]] [[vasoconstriction]] and/or [[coronary spasm|spasm]], which in turn leads to increased arterial shear stress and subsequent [[intimal]] tear or disruption of [[vasa vasorum]].<ref name="PellicciaKaski2017">{{cite journal|last1=Pelliccia|first1=Francesco|last2=Kaski|first2=Juan Carlos|last3=Crea|first3=Filippo|last4=Camici|first4=Paolo G.|title=Pathophysiology of Takotsubo Syndrome|journal=Circulation|volume=135|issue=24|year=2017|pages=2426–2441|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.116.027121}}</ref>  On the contrary, it is noteworthy that the post-ischemic [[myocardial stunning]] associated with SCAD could lead to TCM,<ref name="Y-HassanHenareh2013">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Henareh|first2=Loghman|title=Spontaneous coronary artery dissection triggered post-ischemic myocardial stunning and takotsubo syndrome: two different names for the same condition|journal=Cardiovascular Revascularization Medicine|volume=14|issue=2|year=2013|pages=109–112|issn=15538389|doi=10.1016/j.carrev.2012.11.005}}</ref> thus forming the “TCM begets SCAD, and SCAD begets TCM” vicious cycle.
 
==Causes==
===Life-threatening Causes===
*Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no life-threatening causes of [[disease name]], however complications resulting from untreated [[disease name]] is common.
*Life-threatening causes of [symptom/manifestation] include [cause1], [cause2], and [cause3].
*[Cause] is a life-threatening cause of [disease].
 
===Common Causes===
Common causes of [disease name] may include:
*[Cause1]
*[Cause2]
*[Cause3]
 
 
OR
 
 
*[Disease name] is caused by an infection with [pathogen name].
*[Pathogen name] is caused by [pathogen name].
 
===Less Common Causes===
Less common causes of [disease name] include:
*[Cause1]
*[Cause2]
*[Cause3]
 
===Genetic Causes===
*[Disease name] is caused by a mutation in the [gene name] gene.
 
===Causes by Organ System===
 
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}


===[[Takotsubo]] Cardiomyopathy ([[TCM]])===


===Causes in Alphabetical Order===
* Both [[TCM]] and [[SCAD]] affect predominantly [[women]] and may be precipitated by [[emotional stress]] or [[exercise|strenuous exercise]] associated with [[sympathetic nerve|sympathetic]] discharge.
List the causes of the disease in alphabetical order:
* Numerous reports have described the concurrence of [[TCM]] and [[SCAD]].<ref name="ChouSedlak2015">{{cite journal|last1=Chou|first1=Annie Y.|last2=Sedlak|first2=Tara|last3=Aymong|first3=Eve|last4=Sheth|first4=Tej|last5=Starovoytov|first5=Andrew|last6=Humphries|first6=Karin H.|last7=Mancini|first7=G.B. John|last8=Saw|first8=Jacqueline|title=Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Cardiomyopathy: A Case Series|journal=Canadian Journal of Cardiology|volume=31|issue=8|year=2015|pages=1073.e5–1073.e8|issn=0828282X|doi=10.1016/j.cjca.2015.03.018}}</ref><ref name="Y-HassanHenareh2013">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Henareh|first2=Loghman|title=Spontaneous coronary artery dissection triggered post-ischemic myocardial stunning and takotsubo syndrome: two different names for the same condition|journal=Cardiovascular Revascularization Medicine|volume=14|issue=2|year=2013|pages=109–112|issn=15538389|doi=10.1016/j.carrev.2012.11.005}}</ref><ref name="Y-HassanThemudo2017">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Themudo|first2=Raquel|last3=Maret|first3=Eva|title=Spontaneous coronary artery dissection and takotsubo syndrome: The chicken or the egg causality dilemma|journal=Catheterization and Cardiovascular Interventions|volume=89|issue=7|year=2017|pages=1215–1218|issn=15221946|doi=10.1002/ccd.26956}}</ref><ref name="Y-HassanBöhm2016">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Böhm|first2=Felix|title=The causal link between spontaneous coronary artery dissection and takotsubo syndrome: A case presented with both conditions|journal=International Journal of Cardiology|volume=203|year=2016|pages=828–831|issn=01675273|doi=10.1016/j.ijcard.2015.11.047}}</ref><ref name="YaltaUcar2016">{{cite journal|last1=Yalta|first1=Kenan|last2=Ucar|first2=Fatih|last3=Yilmaztepe|first3=Mustafa|last4=Ozkalayci|first4=Flora|title=Tako-tsubo cardiomyopathy and spontaneous coronary artery dissection: A subtle association with prognostic implications?|journal=International Journal of Cardiology|volume=202|year=2016|pages=174–176|issn=01675273|doi=10.1016/j.ijcard.2015.08.152}}</ref>
<div style="-moz-column-count:3; column-count:3;">
*In the setting of [[TCM]], vigorous contraction of the [[left ventricular]] base in conjunction with the adjacent [[akinetic]]/[[dyskinetic]] segments could form a prerequisite anatomic/functional substrate for the causation of [[SCAD]].<ref name="Madias2015">{{cite journal|last1=Madias|first1=John E.|title=On a Plausible Association of Spontaneous Coronary Artery Dissection and Takotsubo Syndrome|journal=Canadian Journal of Cardiology|volume=31|issue=11|year=2015|pages=1410.e1|issn=0828282X|doi=10.1016/j.cjca.2015.07.720}}</ref> 
* Cause 1
*The [[coronary dissection]] plane may develop as a result of excessive movement of the [[epicardial]] [[vessels]] and increased [[shear stress]] on the [[vessel]] wall at the hinge point between the [[hyperdynamic]] and [[dyskinetic]]/[[akinesia|akinetic]] [[myocardium]].<ref name="Madias2017">{{cite journal|last1=Madias|first1=John E.|title=A Possible Amphidromic Relation Between Spontaneous Coronary Artery Dissection and Takotsubo Syndrome|journal=The American Journal of Cardiology|volume=120|issue=3|year=2017|pages=e69|issn=00029149|doi=10.1016/j.amjcard.2016.10.008}}</ref>
* Cause 2
*The [[coronary arteries]] traversing the anterior or anterolateral wall would be more vulnerable to [[dissection]] as this region marks the transition point of the [[hyperdynamic]] [[basal segment]] and the remaining [[dyskinetic]]/[[akinesia|akinetic]] [[left ventricular]] segments. 
* Cause 3
*Another plausible mechanism is that elevated [[catecholamine]] concentrations in [[TCM]] may cause [[epicardial]] [[coronary]] [[vasoconstriction]] and/or [[coronary spasm|spasm]], which in turn leads to increased [[arterial]] [[shear stress]] and subsequent [[intimal]] tear or disruption of [[vasa vasorum]].<ref name="PellicciaKaski2017">{{cite journal|last1=Pelliccia|first1=Francesco|last2=Kaski|first2=Juan Carlos|last3=Crea|first3=Filippo|last4=Camici|first4=Paolo G.|title=Pathophysiology of Takotsubo Syndrome|journal=Circulation|volume=135|issue=24|year=2017|pages=2426–2441|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.116.027121}}</ref> 
* Cause 4
* The post-[[ischemic]] [[myocardial stunning]] associated with [[SCAD]] could lead to [[TCM]],<ref name="Y-HassanHenareh2013">{{cite journal|last1=Y-Hassan|first1=Shams|last2=Henareh|first2=Loghman|title=Spontaneous coronary artery dissection triggered post-ischemic myocardial stunning and takotsubo syndrome: two different names for the same condition|journal=Cardiovascular Revascularization Medicine|volume=14|issue=2|year=2013|pages=109–112|issn=15538389|doi=10.1016/j.carrev.2012.11.005}}</ref>, thus forming the “[[TCM]] begets [[SCAD]], and [[SCAD]] begets [[TCM]]” vicious cycle.
* Cause 5
* Cause 6
* Cause 7
* Cause 8
* Cause 9
* Cause 10
</div>


==References==
==References==
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[[Category:Angiographic Definitions]]
[[Category:Angiographic Definitions]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Up-To-Date]]

Latest revision as of 12:38, 20 April 2021

Spontaneous Coronary Artery Dissection Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Spontaneous coronary artery dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

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CT

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Echocardiography

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Other Diagnostic Studies

Treatment

Treatment Approach

Medical Therapy

Percutaneous Coronary Intervention

Surgery

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Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Type 1

Type 2A

Type 2B

Type 3

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Nate Michalak, B.A. Arzu Kalayci, M.D. [3]

Synonyms and keywords: SCAD

Overview

The exact etiology of spontaneous coronary artery dissection remains elusive; however, fibromuscular dysplasia and takotsubo cardiomyopathy have been considered as the potential cause of spontaneous coronary artery dissection. The underlying causes associated with SCAD include emotional stress, physical stress such as extreme valsalva maneuver, retching, vomiting, coughing, isometric exercise, history of using stimulant medications or illicit drugs, pregnancy, and connective tissue disorders.

Causes

Common causes associated with spontaneous coronary artery dissection (SCAD) include:[1][2]

Fibromuscular Dysplasia

Takotsubo Cardiomyopathy (TCM)

References

  1. Saw, Jacqueline; Mancini, G.B. John; Humphries, Karin H. (2016). "Contemporary Review on Spontaneous Coronary Artery Dissection". Journal of the American College of Cardiology. 68 (3): 297–312. doi:10.1016/j.jacc.2016.05.034. ISSN 0735-1097.
  2. Saw J (2014). "Coronary angiogram classification of spontaneous coronary artery dissection". Catheter Cardiovasc Interv. 84 (7): 1115–22. doi:10.1002/ccd.25293. PMID 24227590.
  3. Saw, J.; Poulter, R.; Fung, A.; Wood, D.; Hamburger, J.; Buller, C. E. (2012). "Spontaneous Coronary Artery Dissection in Patients With Fibromuscular Dysplasia: A Case Series". Circulation: Cardiovascular Interventions. 5 (1): 134–137. doi:10.1161/CIRCINTERVENTIONS.111.966630. ISSN 1941-7640.
  4. Saw, Jacqueline; Ricci, Donald; Starovoytov, Andrew; Fox, Rebecca; Buller, Christopher E. (2013). "Spontaneous Coronary Artery Dissection". JACC: Cardiovascular Interventions. 6 (1): 44–52. doi:10.1016/j.jcin.2012.08.017. ISSN 1936-8798.
  5. Toggweiler, S; Puck, M; Thalhammer, C; Manka, R; Wyss, M; Bilecen, D; Corti, R; Amann-Vesti, B; Lüscher, T; Wyss, C (2012). "Associated vascular lesions in patients with spontaneous coronary artery dissection". Swiss Medical Weekly. doi:10.4414/smw.2012.13538. ISSN 1424-7860.
  6. Saw, J.; Aymong, E.; Sedlak, T.; Buller, C. E.; Starovoytov, A.; Ricci, D.; Robinson, S.; Vuurmans, T.; Gao, M.; Humphries, K.; Mancini, G. B. J. (2014). "Spontaneous Coronary Artery Dissection: Association With Predisposing Arteriopathies and Precipitating Stressors and Cardiovascular Outcomes". Circulation: Cardiovascular Interventions. 7 (5): 645–655. doi:10.1161/CIRCINTERVENTIONS.114.001760. ISSN 1941-7640.
  7. Lie, J.T.; Berg, K.K. (1987). "Isolated fibromuscular dysplasia of the coronary arteries with spontaneous dissection and myocardial infarction". Human Pathology. 18 (6): 654–656. doi:10.1016/S0046-8177(87)80368-4. ISSN 0046-8177.
  8. Mather PJ, Hansen CL, Goldman B, Inniss S, Piña I, Norris R, Jeevanandam V, Bove AA (1994). "Postpartum multivessel coronary dissection". J. Heart Lung Transplant. 13 (3): 533–7. PMID 8061031.
  9. Brodsky, Sergey V.; Ramaswamy, Gita; Chander, Praveen; Braun, Alex (2007). "Ruptured Cerebral Aneurysm and Acute Coronary Artery Dissection in the Setting of Multivascular Fibromuscular Dysplasia". Angiology. 58 (6): 764–767. doi:10.1177/0003319707303645. ISSN 0003-3197.
  10. Olin, J. W.; Gornik, H. L.; Bacharach, J. M.; Biller, J.; Fine, L. J.; Gray, B. H.; Gray, W. A.; Gupta, R.; Hamburg, N. M.; Katzen, B. T.; Lookstein, R. A.; Lumsden, A. B.; Newburger, J. W.; Rundek, T.; Sperati, C. J.; Stanley, J. C. (2014). "Fibromuscular Dysplasia: State of the Science and Critical Unanswered Questions: A Scientific Statement From the American Heart Association". Circulation. 129 (9): 1048–1078. doi:10.1161/01.cir.0000442577.96802.8c. ISSN 0009-7322.
  11. Chou, Annie Y.; Sedlak, Tara; Aymong, Eve; Sheth, Tej; Starovoytov, Andrew; Humphries, Karin H.; Mancini, G.B. John; Saw, Jacqueline (2015). "Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Cardiomyopathy: A Case Series". Canadian Journal of Cardiology. 31 (8): 1073.e5–1073.e8. doi:10.1016/j.cjca.2015.03.018. ISSN 0828-282X.
  12. 12.0 12.1 Y-Hassan, Shams; Henareh, Loghman (2013). "Spontaneous coronary artery dissection triggered post-ischemic myocardial stunning and takotsubo syndrome: two different names for the same condition". Cardiovascular Revascularization Medicine. 14 (2): 109–112. doi:10.1016/j.carrev.2012.11.005. ISSN 1553-8389.
  13. Y-Hassan, Shams; Themudo, Raquel; Maret, Eva (2017). "Spontaneous coronary artery dissection and takotsubo syndrome: The chicken or the egg causality dilemma". Catheterization and Cardiovascular Interventions. 89 (7): 1215–1218. doi:10.1002/ccd.26956. ISSN 1522-1946.
  14. Y-Hassan, Shams; Böhm, Felix (2016). "The causal link between spontaneous coronary artery dissection and takotsubo syndrome: A case presented with both conditions". International Journal of Cardiology. 203: 828–831. doi:10.1016/j.ijcard.2015.11.047. ISSN 0167-5273.
  15. Yalta, Kenan; Ucar, Fatih; Yilmaztepe, Mustafa; Ozkalayci, Flora (2016). "Tako-tsubo cardiomyopathy and spontaneous coronary artery dissection: A subtle association with prognostic implications?". International Journal of Cardiology. 202: 174–176. doi:10.1016/j.ijcard.2015.08.152. ISSN 0167-5273.
  16. Madias, John E. (2015). "On a Plausible Association of Spontaneous Coronary Artery Dissection and Takotsubo Syndrome". Canadian Journal of Cardiology. 31 (11): 1410.e1. doi:10.1016/j.cjca.2015.07.720. ISSN 0828-282X.
  17. Madias, John E. (2017). "A Possible Amphidromic Relation Between Spontaneous Coronary Artery Dissection and Takotsubo Syndrome". The American Journal of Cardiology. 120 (3): e69. doi:10.1016/j.amjcard.2016.10.008. ISSN 0002-9149.
  18. Pelliccia, Francesco; Kaski, Juan Carlos; Crea, Filippo; Camici, Paolo G. (2017). "Pathophysiology of Takotsubo Syndrome". Circulation. 135 (24): 2426–2441. doi:10.1161/CIRCULATIONAHA.116.027121. ISSN 0009-7322.