PDF(Pubmed)
Abstract：
Spontaneous coronary artery dissection (SCAD) is a rare condition in which there is coronary dissection that is not due to atherosclerosis or iatrogenic causes. It is more common in young women and is associated with risk factors such as the peripartum period and connective tissue disorders. We present five unique cases of SCAD to illustrate the variety of presentations and clinical management. The youngest and oldest patients in our series were 34 and 63 years old, respectively. The majority of our patients (60%) were of African American ethnicity. Two of the patients in the case series developed a new-onset congestive heart failure, and one patient had an iatrogenic complication after intervention. The majority of the patients were treated with conservative medical management (60%), while the others were treated with primary percutaneous coronary intervention (PCI). SCAD is a rare but life-threatening disease that may have varying presentations and precipitating risk factors. As demonstrated in our case series, SCAD may present atypically, and clinicians should maintain a high degree of suspicion in a relevant presentation. Treatment of SCAD may involve conservative management, primary PCI, or coronary artery bypass grafting (CABG) depending on the case. Clinicians may also have to address complications from SCAD, such as cardiomyopathy, that may arise.
摘要：
自发性冠状动脉夹层（SCAD）是一种罕见的疾病，其中冠状动脉夹层不是由于动脉粥样硬化或医源性原因。它在年轻女性中更常见，并且与围产期和结缔组织疾病等危险因素有关。我们介绍了五个独特的SCAD病例，以说明各种表现和临床管理。我们系列中最年轻和最年长的患者分别是34岁和63岁，分别。我们的大多数患者（60％）是非裔美国人。病例系列中的两名患者出现了新的充血性心力衰竭，一名患者在干预后出现医源性并发症。大多数患者接受保守医疗管理（60％），而其他人则接受了直接经皮冠状动脉介入治疗（PCI）。SCAD是一种罕见但危及生命的疾病，可能有不同的表现和危险因素。如我们的案例系列所示，SCAD可能非典型地出现，临床医生应在相关陈述中保持高度怀疑。SCAD的治疗可能涉及保守治疗，原发性PCI或冠状动脉旁路移植术（CABG），视情况而定。临床医生可能还必须解决SCAD的并发症，比如心肌病，这可能会出现。
