Spontanous coronary artery dissection: A case report
Notice bibliographique
Résumé
Spontaneous Coronary Artery Dissection (SCAD) is a rare aetiology of acute coronary syndrome (ACS), characterised by intramural haematoma formation in coronary arteries unrelated to atherosclerosis or trauma. It is often overlooked in young women with ACS symptoms, leading to adverse outcomes. Timely diagnosis and management are crucial. This case report details a middle-aged female with SCAD presenting with chest pain. A 40-year-old woman presented with worsening retrosternal chest pain over 2 months, associated with elevated stress levels. Her medical history includes untreated hypercholesterolaemia (cholesterol 6.8 mmol/L, triglycerides 3.48 mmol/L, LDL-c 6.0 mmol/L), non-fatty alcoholic liver disease, and smoking. Initial ECG findings showed T-wave inversion, saddle ST segments, and elevated troponin levels. Echocardiography displayed moderate left ventricular dysfunction, with lateral, inferior, and posterior wall motion abnormalities. The working diagnosis was ACS. Thorough clinical examination and investigations ruled out differentials including pneumonia, pulmonary embolism, aortic dissection, myocarditis and Takotsubo's cardiomyopathy. Coronary angiography revealed left main stem/left anterior descending artery stenosis with SCAD, confirmed by subsequent CT coronary angiography. Conservative management was employed, and follow-up cardiac MRI at 6 months post-SCAD was reassuring, showing preserved myocardial thickness and LAD territory scarring with no significant ischaemic changes. SCAD, though rare, may be underdiagnosed due to diagnostic challenges.1 It mimics ACS secondary to coronary artery disease and its reliance on coronary angiography causes delayed diagnosis in non-PCI centres.2 Conservative management is recommended for uncomplicated cases, supported by cardiac rehabilitation and moderate exercise.3 Post-SCAD chest pain is common.4 Research from Canada and the United Kingdom have also led to the establishment of specialised SCAD clinics to manage this rare condition.5 Hypertension increases the risk of recurrent SCAD; therefore good blood pressure management is vital.6 Imaging is recommended to identify extra-coronary high-risk aneurysms or dissections linked to underlying arteriopathies.7 For example, SCAD often coexists with Fibromuscular Dysplasia (FMD), an arteriopathy affecting medium-sized arteries leading to stenosis and aneurysm formation.8 Typically patients are females aged between 20 and 60 years. The cause of FMD is unknown, and diagnosis is made by angiography. Despite initial reports, less than 5% of SCAD cases are related to pregnancy.9 Hormonal changes with high progesterone levels can result in weakening of the vessel wall. Increased cardiac output and circulatory volume, along with the acute haemodynamic stress of childbirth can lead to pregnancy-related SCAD.10
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».