| 词条 | Spontaneous coronary artery dissection |
| 释义 |
| name = Spontaneous coronary artery dissection | synonyms = | image = | caption = | pronounce = | field = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} A spontaneous coronary artery dissection (SCAD) (occasionally coronary artery dissection) is a rare, sometimes fatal traumatic condition, with eighty percent of cases affecting women. One of the coronary arteries develops a tear, causing blood to flow between the layers which forces them apart.[1] Studies of the disease place the mortality rate at around 70%.[2][3] SCAD is a primary cause of myocardial infarction (MI) in young, fit, healthy women (and some men) with no obvious risk factors. These can often occur during late pregnancy, postpartum and peri-menopausal periods. Signs and symptomsThe symptoms are often very similar to those of myocardial infarction (heart attack), with the most common being persistent chest pain.[4] Other symptoms can include rapid heartbeat, shortness of breath, sweating, extreme tiredness, nausea, and dizziness.[5] CausesSCADThere is evidence to suggest that a major cause of spontaneous coronary artery dissection (SCAD) is related to female hormone levels, as most cases appear to arise in pre-menopausal women, although there is evidence that the condition can have various triggers. Other underlying conditions such as hypertension, recent delivery of a baby, fibromuscular dysplasia and connective-tissue disorders (e.g., Marfan syndrome and Ehlers-Danlos syndrome) may occasionally result in SCAD.[6] There is also a possibility that vigorous exercise can be a trigger. However, many cases have no obvious cause.[7][8] PathophysiologyCoronary artery dissection results from a tear in the inner layer of the artery, the tunica intima. This allows blood to penetrate and cause an intramural hematoma in the central layer, the tunica media, and a restriction in the size of the lumen, resulting in reduced blood flow which in turn causes myocardial infarction and can later cause sudden cardiac death.[9][10][11] DiagnosisA selective coronary angiogram is the most common method to diagnose the condition, although it is sometimes not recognised until after death.[12][13]Intravascular ultrasound (IVUS) is also used as it is able to more easily differentiate the condition from atherosclerotic disease.[14] TreatmentTreatment is varied depending upon the nature of the case. In asymptomatic and hemodynamically stable patients it may be appropriate to maintain a conservative strategy, especially if coronarography demonstrates adequate coronary flow: in this situation spontaneous healing is usually the most probable evolution.[15] In severe cases, coronary artery bypass surgery is performed to redirect blood flow around the affected area.[16][17]Drug-eluting stents and thrombolytic drug therapy are less invasive options for less severe cases.[14] However PCI for spontaneous coronary artery dissection is associated with high rates of technical failure, so in many case a strategy of conservative management may be preferable. According to some sources, while heart attack patients may require a procedure, SCAD may benefit from a more conservative therapy that focuses on controlling blood pressure, such as beta blockers.[18] PrognosisThe condition is often fatal and is mostly recognized at postmortem examination in young victims of sudden death.[19][20] EpidemiologyThe prevalence of spontaneous coronary dissection varies from about 1% to 4% of all coronarography. About eighty percent of cases are in women, with an average age of around 40.[21][22][23][24] SCAD is the most common cause of pregnancy-associated myocardial infarction [25] HistorySpontaneous coronary artery dissection (SCAD) was first described in the year 1931, at postmortem examination, in a 42 year old woman.[26] See also
References1. ^{{cite journal | vauthors = Slight R, Behranwala AA, Nzewi O, Sivaprakasam R, Brackenbury E, Mankad P | date = 2003 | url = http://www.nzma.org.nz/journal/116-1181/585/ | title = Spontaneous coronary artery dissection: a report of two cases occurring during menstruation | archive-url = https://web.archive.org/web/20100409141257/http://www.nzma.org.nz/journal/116-1181/585/ | archive-date=2010-04-09 | dead-url = yes | journal = New Zealand Medical Journal }} 2. ^{{cite journal | vauthors = DeMaio SJ, Kinsella SH, Silverman ME | title = Clinical course and long-term prognosis of spontaneous coronary artery dissection | journal = The American Journal of Cardiology | volume = 64 | issue = 8 | pages = 471–4 | date = September 1989 | pmid = 2773790 | doi = 10.1016/0002-9149(89)90423-2 }} 3. ^{{cite journal | vauthors = Khan NU, Miller MJ, Babb JD, Ahmed S, Saha PK, Shammas RL, Macdonald RG, Movahed A | title = Spontaneous coronary artery dissection | journal = Acute Cardiac Care | volume = 8 | issue = 3 | pages = 162–71 | year = 2006 | pmid = 17012132 | doi = 10.1080/17482940600789190 }} 4. ^"Spontaneous Coronary Artery Dissection Postpartum" 5. ^{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/symptoms-causes/syc-20353711?p=1|title=Symptoms and causes - Mayo Clinic|website=www.mayoclinic.org|language=en|access-date=2018-11-07}} 6. ^Dhawan R, Singh G, Fesniak H. (2002) "Spontaneous coronary artery dissection: the clinical spectrum". Angiology 7. ^Mark V. Sherrid; Jennifer Mieres; Allen Mogtader; Naresh Menezes; Gregory Steinberg (1995) "Onset During Exercise of Spontaneous Coronary Artery Dissection and Sudden Death. Occurrence in a Trained Athlete: Case Report and Review of Prior Cases" Chest 8. ^{http://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/basics/risk-factors/con-20037794} 9. ^Virmani R, Forman MB, Rabinowitz M, McAllister HA (1984) "Coronary artery dissections" Cardiol Clinics 10. ^Kamineni R, Sadhu A, Alpert JS. (2002) "Spontaneous coronary artery dissection: Report of two cases and 50-year review of the literature" Cardiol Rev 11. ^{{cite journal | vauthors = Kamran M, Guptan A, Bogal M | title = Spontaneous coronary artery dissection: case series and review | journal = The Journal of Invasive Cardiology | volume = 20 | issue = 10 | pages = 553–9 | date = October 2008 | pmid = 18830003 }} 12. ^C. Basso, G. L. Morgagni, G. Thiene (1996) "Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death" BMJ 13. ^{{cite journal | vauthors = Desseigne P, Tabib A, Loire R | title = [An unusual cause of sudden death: spontaneous dissection of coronary arteries. Apropos of 2 cases] | journal = Archives Des Maladies Du Coeur Et Des Vaisseaux | volume = 85 | issue = 7 | pages = 1031–3 | date = July 1992 | pmid = 1449336 }} 14. ^1 Intravascular Ultrasound Imaging in the Diagnosis and Treatment: The Future: IVUS-Guided DES Implantation? 15. ^{{cite journal | vauthors = Alfonso F, Paulo M, Lennie V, Dutary J, Bernardo E, Jiménez-Quevedo P, Gonzalo N, Escaned J, Bañuelos C, Pérez-Vizcayno MJ, Hernández R, Macaya C | title = Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a "conservative" therapeutic strategy | journal = JACC. Cardiovascular Interventions | volume = 5 | issue = 10 | pages = 1062–70 | date = October 2012 | pmid = 23078737 | doi = 10.1016/j.jcin.2012.06.014 }} 16. ^MedHelp:Coronary artery dissection treatment 17. ^{{cite journal | vauthors = Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS, Holmes DR, Hayes SN, Gulati R | title = Spontaneous coronary artery dissection: revascularization versus conservative therapy | journal = Circulation: Cardiovascular Interventions | volume = 7 | issue = 6 | pages = 777–86 | date = December 2014 | pmid = 25406203 | doi = 10.1161/CIRCINTERVENTIONS.114.001659 }} 18. ^{{Cite web|url=https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks/coronary-artery-dissection-not-just-a-heart-attack|title=Coronary Artery Dissection: Not Just a Heart Attack|website=www.heart.org|language=en|access-date=2018-11-07}} 19. ^{{cite journal | vauthors = Le MQ, Ling FS | title = Spontaneous dissection of the left main coronary artery treated with percutaneous coronary stenting | journal = The Journal of Invasive Cardiology | volume = 19 | issue = 8 | pages = E218-21 | date = August 2007 | pmid = 17712209 | doi = | url = http://www.invasivecardiology.com/article/7561 }} 20. ^{{cite journal | vauthors = Auer J, Punzengruber C, Berent R, Weber T, Lamm G, Hartl P, Eber B | title = Spontaneous coronary artery dissection involving the left main stem: assessment by intravascular ultrasound | journal = Heart | volume = 90 | issue = 7 | pages = e39 | date = July 2004 | pmid = 15201265 | pmc = 1768303 | doi = 10.1136/hrt.2004.035659 }} 21. ^Hayes, S (2013), New Insights into This Not-So-Rare Condition 22. ^{{cite journal | vauthors = Vanzetto G, Berger-Coz E, Barone-Rochette G, Chavanon O, Bouvaist H, Hacini R, Blin D, Machecourt J | title = Prevalence, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection: results from a database of 11,605 patients | journal = European Journal of Cardio-Thoracic Surgery | volume = 35 | issue = 2 | pages = 250–4 | date = February 2009 | pmid = 19046896 | doi = 10.1016/j.ejcts.2008.10.023 }} 23. ^{{cite journal | vauthors = Yip A, Saw J | title = Spontaneous coronary artery dissection-A review | journal = Cardiovascular Diagnosis and Therapy | volume = 5 | issue = 1 | pages = 37–48 | date = February 2015 | pmid = 25774346 | pmc = 4329168 | doi = 10.3978/j.issn.2223-3652.2015.01.08 }} 24. ^{{cite journal | vauthors = Fontanelli A, Olivari Z, La Vecchia L, Basso C, Pagliani L, Marzocchi A, Zonzin P, Vassanelli C, Di Pede F | title = Spontaneous dissections of coronary arteries and acute coronary syndromes: rationale and design of the DISCOVERY, a multicenter prospective registry with a case-control group | journal = Journal of Cardiovascular Medicine | volume = 10 | issue = 1 | pages = 94–9 | date = January 2009 | pmid = 19708230 | doi = | url = http://Insights.ovid.com/pubmed?pmid=19708230 | url-access = subscription }} 25. ^{{cite journal | vauthors = Hayes SN, Kim ES, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, Ganesh SK, Gulati R, Lindsay ME, Mieres JH, Naderi S, Shah S, Thaler DE, Tweet MS, Wood MJ | title = Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association | journal = Circulation | volume = 137 | issue = 19 | pages = e523-e557 | date = May 2018 | pmid = 29472380 | pmc = 5957087 | doi = 10.1161/CIR.0000000000000564 }} 26. ^{{cite journal |vauthors=Pretty HC |title=Dissecting aneurysm of coronary artery in a woman aged 42 |journal=British Medical Journal |volume=1 |issue=3667 |page=667 |date=18 April 1931 |doi=10.1136/bmj.1.3667.667}} External links{{Medical resources| DiseasesDB = 3115 | ICD10 = {{ICD10|I|25|4|i|20}} | ICD9 = {{ICD9|414.12}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = }}
3 : Diseases of the aorta|Heart diseases|Causes of death |
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