Spontaneous coronary artery dissection: a report of three cases and review of the literature
Key result
Spontaneous coronary artery dissection in 3 young women presented with a spectrum from unstable angina to sudden death, with 2 fatal cases and 1 requiring coronary artery bypass grafting.
Population
3 young women with spontaneous coronary artery dissection (one 9 weeks pregnant) presenting with chest pain
Design
Case_series
Authors
Discussion
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Implication
SCAD can prove rapidly fatal in young women; case reports leave open optimal prevention and management strategies.
Key Points
- Examine the clinical spectrum, histopathology, and therapeutic management of spontaneous coronary artery dissection in young women.
- Analyzed the clinical presentations and outcomes of 3 young women with spontaneous coronary artery dissection, including one presenting at 9 weeks of gestation.
- Performed post-mortem histopathological examinations in two fatal cases and diagnostic coronary angiography in the surviving case.
- Reviewed published literature regarding proposed etiologic mechanisms and treatment modalities, including surgical revascularization and conservative therapy.
- Two patients died from sudden cardiac arrest or cardiogenic shock complicating myocardial infarction, whereas one patient survived after left anterior descending artery bypass grafting.
- Histopathology demonstrated large intramural hematomas in the outer third of the arterial media that caused complete compression of the true lumen.
- The left anterior descending artery was identified as the predominantly affected vessel, with proposed etiologies including eosinophilic angiitis and pregnancy-related collagen disruption.
Study Design
Type
Case Report (n=3)
Structured PICO
P
Population
3 young women with spontaneous coronary artery dissection (one 9 weeks pregnant) presenting with chest pain
O
Outcome
Clinical course and survivalhard clinical
Spontaneous coronary artery dissection is a rare but severe cause of ischemic events in young women, often associated with pregnancy, and can rapidly progress to cardiogenic shock or sudden death.
Cite This Study
Kearney et al. (1993) conducted a case report in Spontaneous coronary artery dissection (n=3). Spontaneous coronary artery dissection in 3 young women presented with a spectrum from unstable angina to sudden death, with 2 fatal cases and 1 requiring coronary artery bypass grafting.