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Cardiac conditions
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Spontaneous coronary artery dissection (SCAD) is considered to be the most common cause of pregnancy-associated myocardial infarction55. In pregnancy, SCAD occurs commonly in late pregnancy or the early puerperal period. The highest incidence is found to occur immediately after delivery, and this is suggested to be caused by a combination of elevated cardiac output, increased total blood volume and sheering forces during labour with increasing catecholamine stimulus due to pain56. There is also a close association with connective tissue disorders57.
Vascular Disease and Dissection in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Spontaneous coronary artery dissection (SCAD) occurs when an intimal tear or bleeding of the vasa vasorum causes an intramedial hemorrhage and a false lumen that fills with intramural hematoma and expands under pressure. SCAD can occur with or without atherosclerosis. The most frequently affected vessel is the left anterior descending artery in approximately 40%–70% of cases [13,42] (Figure 13.1). Dissection often occurs in a single coronary artery, but multiple vessels and noncontiguous segments can be involved [10,43]. Patients may present with STEMI, NSTEMI, or life-threatening arrhythmias.
OCT assessment in spontaneous coronary artery dissection
Published in Hiram G. Bezerra, Guilherme F. Attizzani, Marco A. Costa, OCT Made Easy, 2017
Christopher Franco, Lim Eng, Jacqueline Saw
Spontaneous coronary artery dissection (SCAD) is a clinically challenging entity that is an important cause of both acute myocardial ischemia and infarction and sudden cardiac death, especially in women. The first case of SCAD was described on autopsy by Pretty et al. in 1931 of a 41-year-old woman presenting with sudden cardiac death who did not have risk factors for atherosclerotic disease.1 The first angiographic report of SCAD was in 1973 by Forker et al. describing the angiographic appearance of extraluminal dye.2 Since then, fewer than 1000 cases of SCAD have been noted in the medical literature. Retrospective registries have reported SCAD in 0.07%–1.1% of all coronary angiograms.3–6 Previous reports have alluded to the rare observation of SCAD as a causative element in acute coronary syndrome (ACS) and sudden cardiac death, accounting for 0.1%–4% and 0.4%, respectively.5,7 In a series by Vanzetto et al., the prevalence was higher among young women age <50, accounting for 8.7% of troponin-positive ACS.3 We recently described a retrospective review of women under age 50 undergoing coronary angiography, and 24% had angiographically detectable SCAD.1,8 Taken together, these data suggest that SCAD is much more prevalent than previously observed, but at present, the true population-based incidence of SCAD remains unknown.
Contemporary trends in the incidence of spontaneous coronary artery dissection (SCAD) – ethnic and household income disparities
Published in Expert Review of Cardiovascular Therapy, 2022
Mohsin S Mughal, Hafsa Akbar, Ikwinder P Kaur, Ali R Ghani, Hasan Mirza, Weiyi Xia, Mohammed Haris Usman, Mahboob Alam, Tarek Helmy
Spontaneous coronary artery dissection (SCAD) is an under-recognized condition that occurs due to the non-iatrogenic tear of the coronary arterial wall. SCAD can impede the blood flow to myocardium and present as acute coronary syndrome, arrhythmias, or sudden death. The underlying pathophysiology is unclear; however, fibromuscular dysplasia (FMD), extracoronary vasculopathy, systemic arteriopathies, pregnancy, and physical and emotional stresses have been characterized as potential associations, while their causality is yet to be proven. In the last decade, as more evidence is accumulating, SCAD is increasingly recognized, which may contribute to 35% of acute coronary syndrome (ACS) among women ≤50 years of age [1]. Data regarding the incidence of SCAD is growing. Utilizing the NIS in a nationwide sample from 2010 to 2017, we aimed to investigate the overall incidence, as well as the trends of SCAD incidence based on race (White, African American, Hispanic, and others), household income, and the U.S. census regions: CENS-R1 (Census Region 1: Northeast), CENS-R2 (Census Region 2: Midwest), CENS-R3 (Census Region 3: South), and CENS-R4 (Census Region 4: West).
Cardiac rehabilitation following coronary artery dissection: recommendations and patient considerations
Published in Expert Review of Cardiovascular Therapy, 2021
Rohit Samuel, Mesfer Alfadhel, Cameron McAlister, Thomas Nestelberger, Jacqueline Saw
Spontaneous coronary artery dissection (SCAD) is an important cause of AMI, particularly in young women with minimal atherosclerotic risk factors [40]. It is defined as a spontaneous separation of the coronary artery wall that is not iatrogenic or related to trauma. The true prevalence of SCAD is unclear due to underdiagnosis, but it is increasingly recognized as a cause of AMI, especially in young women without traditional coronary risk factors [6]. Women make up between 87% and 95% of SCAD presentations with a mean age between 44 and 53 years at time of event [41]. It is estimated that SCAD is implicated in 1% to 4% of ACS overall, based on registry data and case series [42–44]. There is a large variability in physician comfort in assessing and managing SCAD patients, given this relative rarity [45]. The prevalence of SCAD is much greater when considering ACS in young women, ranging from 24% to 35% in two retrospective datasets [46,47]. Furthermore, there is a high rate of recurrence for SCAD, 10.4% over a median follow-up of 3.1 years in our series, which emphasizes the need for useful interventions to reduce future morbidity and mortality [48].
Gender differences in the clinical features and outcomes of patients with coronary artery disease
Published in Expert Review of Cardiovascular Therapy, 2019
Hideki Wada, Katsumi Miyauchi, Hiroyuki Daida
Women have vessels with a smaller diameter, whereas men have a higher prevalence of multivessel and left main coronary artery disease [32,35]. Sex differences in atherosclerosis also exist. Some studies have demonstrated that women had a lower prevalence and reduced severity of coronary artery calcification [36,37]. A recent study on a large population of patients who underwent cardiac catheterization and optical coherence tomography showed smaller amounts of lipid and less frequent cholesterol crystals and calcifications in women, despite the greater prevalence of coronary risk factors [38]. Furthermore, histological studies have reported that the culprit lesions of ACS or sudden cardiac death had less extensive atherosclerosis and evidence of rupture but a higher prevalence of plaque erosion among women, particularly those who were younger [39,40]. This might be one of the explanations for ACS without obstructive CAD being more common in younger age groups and women. Women are also more likely to have unusual CAD pathophysiology, such as coronary spastic angina or spontaneous coronary artery dissection [41,42].