Coronary artery dissection
Classification and external resources
ICD-10	I25.4
ICD-9	414.12
DiseasesDB	3115

A coronary artery dissection (also known as spontaneous coronary artery dissection, or SCAD) is a rare, sometimes fatal traumatic condition, with eighty percent of cases affecting women. The coronary artery develops a tear, causing blood to flow between the layers which forces them apart.^[1] Early studies of the disease placed mortality rates at around 70%, but more recent evidence suggests a figure of around 20%^[2][3] The condition is often seen to be related to female hormone levels, as well as other pre-existing cardiovascular conditions. In addition to this, a dissection can occur iatrogenically, by the surgical inserion of a catheter into the coronary artery.^[4]

Contents 1 Signs and symptoms 2 Causes 2.1 SCAD 2.2 Iatrogenesis 3 Pathophysiology 4 Diagnosis 5 Treatment 6 Epidemiology 7 See Also 8 References 9 External Links

[edit] Signs and symptoms

The symptoms are often very similar to those of myocardial infarction (heart attack), with the most common being persistent chest pain.^[5]

[edit] Causes

[edit] SCAD

There 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 may sometimes be causes.^[6] There is also a possiblility that exercise can be a trigger. However cases sometimes have no obvious cause.^[7]

[edit] Iatrogenesis

It has been recognised that some instances are iatrogenic, as it can be caused by the insertion of a catheter into the coronary artery.^[4]

[edit] Pathophysiology

Coronary 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.^[8][9]

[edit] Diagnosis

A selective coronary angioplasty is the most common method to diagnose the condition, although it is sometimes not recognised until after death.^[10] Intravascular ultrasound (IVUS) is also used as it is able to more easily differentiate the condition from atherosclerotic disease.^[11]

[edit] Treatment

Treatment is varied depending upon the nature of the case. In severe cases, coronary artery bypass surgery is performed to redirect blood flow around the affected area.^[12] Drug-eluting stents and thrombolytic drug therapy are less invasive options for less severe cases.^[11]

[edit] Epidemiology

Eighty percent of cases are in women, and a third late in pregnancy or shortly after. 

[edit] See Also

• Dissection (medical)
• Aortic dissection, a similar condition affecting a different artery

[edit] References

[edit] External Links

• "Spontaneous Coronary Artery Dissection Postpartum"

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