Coronary artery dissection: Difference between revisions
ClaireLewis (talk | contribs) |
No edit summary |
||
| Line 3: | Line 3: | ||
===Causes=== | ===Causes=== | ||
*Hormonal changes in vessel wall | *Hormonal changes in vessel wall (eg pregnancy, contraceptives) | ||
*Shear forces | *Shear forces | ||
*Fibromuscular dysplasia | |||
*Underling [[connective tissue disorder]] | *Underling [[connective tissue disorder]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Chest or shoulder pain | |||
*Syncope | |||
*Dyspnea | |||
*Diaphoresis | |||
*Nausea | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 13: | Line 19: | ||
==Evaluation== | ==Evaluation== | ||
*Diagnosis made at time of coronary angiography | |||
==Management== | ==Management== | ||
*Aspirin, beta blocker, and 1 year of clopidogrel<ref>Saw J, Aymong E, Sedlak T, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv 2014; 7:645.</ref> | |||
*PCI can be challenging given vessel wall fragility | |||
==Disposition== | ==Disposition== | ||
| Line 20: | Line 29: | ||
==See Also== | ==See Also== | ||
*[[Chest Pain]] | *[[Chest Pain]] | ||
*[[ST-segment_elevation_myocardial_infarction_(STEMI)|STEMI]] | |||
==References== | ==References== | ||
Revision as of 00:40, 20 March 2017
Background
- Usually presents as an Anterior MI with ST changes in anterior Precordial leads (V1-V3)
Causes
- Hormonal changes in vessel wall (eg pregnancy, contraceptives)
- Shear forces
- Fibromuscular dysplasia
- Underling connective tissue disorder
Clinical Features
- Chest or shoulder pain
- Syncope
- Dyspnea
- Diaphoresis
- Nausea
Differential Diagnosis
ST Elevation
- Cardiac
- ST-segment elevation myocardial infarction (STEMI)
- Post-MI (ventricular aneurysm pattern)
- Previous MI with recurrent ischemia in same area
- Wellens' syndrome
- Coronary artery vasospasm (eg, Prinzmetal's angina)
- Coronary artery dissection
- Pericarditis
- Myocarditis
- Aortic dissection in to coronary
- Left ventricular aneurysm
- Left ventricular pseudoaneurysm
- Early repolarization
- Left bundle branch block
- Left ventricular hypertrophy (LVH)
- Myocardial tumor
- Myocardial trauma
- RV pacing (appears as Left bundle branch block)
- Brugada syndrome
- Takotsubo cardiomyopathy
- AVR ST elevation
- Other thoracic
- Metabolic
- Drugs of abuse (eg, cocaine, crack, meth)
- Hyperkalemia (only leads V1 and V2)
- Hypothermia ("Osborn J waves")
- Medications
Evaluation
- Diagnosis made at time of coronary angiography
Management
- Aspirin, beta blocker, and 1 year of clopidogrel[1]
- PCI can be challenging given vessel wall fragility
Disposition
See Also
References
- ↑ Saw J, Aymong E, Sedlak T, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv 2014; 7:645.