Spontaneous coronary artery dissection: dissecting an underdiagnosed problem
Netherlands Heart Journal, vol. 33, pp. 385–394
Abstract
Spontaneous coronary artery dissection (SCAD) occurs in 1-4% of acute coronary syndromes (ACS). In SCAD, an intramural hematoma compresses the true lumen of the coronary artery, leading to ischemia and, even acute myocardial infarction.Approximately, 90% percent of SCAD patients are premenopausal women without classical risk factors for atherosclerosis. The gold standard for diagnosis is invasive coronary angiography and optical coherence tomography or intravascular ultrasound can be useful tools to confirm the diagnosis. Coronary intervention with stent placement is generally not recommended unless there is complete occlusion of the coronary artery with ongoing ischemia. In the acute phase, antiplatelet therapy and beta-blockers are advised, which are usually continued for life. Despite medical treatment, 10-20% of SCAD patients experience a recurrence within 4 years. Nearly two-thirds of SCAD patients have fibromuscular dysplasia (FMD) based on CT angiography. Current treatment recommendations are based on expert opinion. Therapy and follow-up are advised to include at least one antiplatelet agent, a beta-blocker, screening for FMD, cardiac rehabilitation and among patients with left ventricular systolic dysfunction ACE inhibitor or aldosterone receptor blocker. Randomized controlled trials have been initiated to evaluate the treatment effects of beta-blocker and antiplatelet therapy in SCAD patients.
Authors 8
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Deborah N. Kalkman corresponding
Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · University of Amsterdam
Affiliation as printed
Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands. d.n.kalkman@amsterdamumc.nl
Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC—University of Amsterdam, Amsterdam, The Netherlands
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Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · University of Amsterdam
Affiliation as printed
Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC—University of Amsterdam, Amsterdam, The Netherlands
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Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · University of Amsterdam
Affiliation as printed
Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC—University of Amsterdam, Amsterdam, The Netherlands
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Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Internal Medicine, Division of Vascular Medicine, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
Department of Internal Medicine, Division of Vascular Medicine, Amsterdam UMC—University of Amsterdam, Amsterdam, The Netherlands
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Maastricht University · St. Antonius Ziekenhuis
Affiliation as printed
Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · University of Amsterdam
Affiliation as printed
Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC—University of Amsterdam, Amsterdam, The Netherlands
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Affiliation as printed
Department of Cardiology, Dijklander Ziekenhuis-Hoorn & Purmerend, Hoorn, The Netherlands
Department of Cardiology, Dijklander Ziekenhuis—Hoorn & Purmerend, Hoorn, The Netherlands
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