Coronary artery dissection

From WikEM
(Redirected from Coronary Artery Dissection)
Jump to: navigation, search

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

Evaluation

  • Diagnosis made at time of coronary angiography

Management

  • Aspirin, β-blocker, and 1 year of clopidogrel[1]
  • PCI can be challenging given vessel wall fragility

Disposition

See Also

References

  1. 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.