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Spontaneous Coronary Artery Dissection and Pregnancy

  • Sahar NaderiEmail author
Pregnancy and Cardiovascular Disease (N Scott, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pregnancy and Cardiovascular Disease

Opinion statement

Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic, non-traumatic cause of coronary artery dissection. SCAD is the most common cause of myocardial infarction in pregnancy or the postpartum period and results in significant cardiovascular morbidity and mortality in the pregnant population. It is important to consider pregnancy-associated spontaneous coronary artery dissection (PASCAD) high on the differential for a pregnant woman who presents with symptoms consistent with acute coronary syndrome. Management of these patients requires a thoughtful, multidisciplinary approach, with consideration of conservative management if possible. Counseling regarding future pregnancies is also critical and requires compassionate care. Given our limited understanding of SCAD, including PASCAD, more data and research are needed to help guide diagnosis, management, and determination of prognosis.

Keywords

Pregnancy Cardiovascular disease Spontaneous coronary artery dissection Acute coronary syndrome 

Notes

Compliance with Ethical Standards

Conflict of Interest

The author declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

  1. 1.
    Paulo M, Sandoval J, Lennie V, Dutary J, Medina M, Gonzalo N, et al. Combined use of OCT and IVUS in spontaneous coronary artery dissection. JACC Cardiovasc Imaging. 2013;6:830–2.Google Scholar
  2. 2.
    Asuncion CM, Hyun J. Dissecting intramural hematoma of the coronary artery in pregnancy and the puerperium. Obstet Gynecol. 1972;40:202–10.PubMedGoogle Scholar
  3. 3.
    Sivam S, Yozghatlian V, Dentice R, McGrady M, Moriarty C, Di Michiel J, et al. Spontaneous coronary artery dissection associated with coughing. J Cyst Fibros. 2014;13:235–7.Google Scholar
  4. 4.
    Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv. 2014;7:645–55.Google Scholar
  5. 5.
    Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, et al. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012;126:579–88.Google Scholar
  6. 6.
    Nakashima T, Noguchi T, Haruta S, Yamamoto Y, Oshima S, Nakao K, et al. Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: a report from the Angina Pectoris-Myocardial Infarction Multicenter Investigators in Japan. Int J Cardiol. 2016;207:341–8.Google Scholar
  7. 7.
    Saw J, Poulter R, Fung A, Wood D, Hamburger J, Buller CE. Spontaneous coronary artery dissection in patients with fibromuscular dysplasia: a case series. Circ Cardiovasc Interv. 2012;5:134–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Prasad M, Tweet MS, Hayes SN, Leng S, Liang JJ, Eleid MF, et al. Prevalence of extracoronary vascular abnormalities and fibromuscular dysplasia in patients with spontaneous coronary artery dissection. Am J Cardiol. 2015;115:1672–7.Google Scholar
  9. 9.
    Kadian-Dodov D, Gornik HL, Gu X, Froehlich J, Bacharach JM, Chi YW, et al. Dissection and aneurysm in patients with fibromuscular dysplasia: findings from the US Registry for FMD. J Am Coll Cardiol. 2016;68:176–85.Google Scholar
  10. 10.
    Pretty H. Dissecting aneurysm of coronary artery in a woman aged 42: rupture. British Medical Journal. 1931;667Google Scholar
  11. 11.
    Rogowski S, Maeder MT, Weilenmann D, Haager PK, Ammann P, Rohner F, et al. Spontaneous coronary artery dissection: angiographic follow-up and long-term clinical outcome in a predominantly medically treated population. Catheter Cardiovasc Interv. 2017;89:59–68.Google Scholar
  12. 12.
    Elkayam U, Jalnapurkar S, Barakkat MN, Khatri N, Kealey AJ, Mehra A, et al. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Circulation. 2014;129:1695–702.Google Scholar
  13. 13.
    Havakuk O, Goland S, Mehra A, Elkayam U. Pregnancy and the risk of spontaneous coronary artery dissection: an analysis of 120 contemporary cases. Circ Cardiovasc Interv. 2017;10Google Scholar
  14. 14.
    Sheikh AS, O’Sullivan M. Pregnancy-related spontaneous coronary artery dissection: two case reports and a comprehensive review of literature. Heart Views. 2012;13:53–65.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Vijayaraghavan R, Verma S, Gupta N, Saw J. Pregnancy-related spontaneous coronary artery dissection. Circulation. 2014;130:1915–20.CrossRefPubMedGoogle Scholar
  16. 16.
    Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33:130–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Koller PT, Cliffe CM, Ridley DJ. Immunosuppressive therapy for peripartum-type spontaneous coronary artery dissection: case report and review. Clin Cardiol. 1998;21:40–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Kamineni R, Sadhu A, Alpert JS. Spontaneous coronary artery dissection: report of two cases and a 50-year review of the literature. Cardiol Rev. 2002;10:279–84.CrossRefPubMedGoogle Scholar
  19. 19.
    Narouze S, Benzon HT, Provenzano DA, Buvanendran A, De Andres J, Deer TR, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2015;40:182–212.Google Scholar
  20. 20.
    Briguori C, Bellevicine C, Visconti G, Focaccio A, Aprile V, Troncone G. In vivo histological assessment of a spontaneous coronary artery dissection. Circulation. 2010;122:1044–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Vance CJ, Taylor RN, Craven TE, Edwards MS, Corriere MA. Increased prevalence of preeclampsia among women undergoing procedural intervention for renal artery fibromuscular dysplasia. Ann Vasc Surg. 2015;29:1105–10.CrossRefPubMedGoogle Scholar
  22. 22.
    Tweet MS, Hayes SN, Gulati R, Rose CH, Best PJ. Pregnancy after spontaneous coronary artery dissection: a case series. Ann Intern Med. 2015;162:598–600.CrossRefPubMedGoogle Scholar
  23. 23.
    European Society of G, Association for European Paediatric C, German Society for Gender M, Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, et al., Guidelines ESCCfP. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:3147–97.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of CardiologyStanford University Medical CenterStanfordUSA

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