Coronary artery dissection: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Chest or shoulder pain | *[[Chest pain|Chest]] or shoulder pain | ||
*Syncope | *[[Syncope]] | ||
*Dyspnea | *[[Dyspnea]] | ||
*Diaphoresis | *Diaphoresis | ||
*Nausea | *[[Nausea]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
*Aspirin, β-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> | *[[Aspirin]], [[beta-blockers|β-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 | *PCI can be challenging given vessel wall fragility | ||
Revision as of 18:37, 24 September 2019
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
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, β-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.