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Spontaneous coronary artery dissection, which heart disease is associated with

By Cristiano Antonino On Apr 27, 2023

Spontaneous coronary artery dissection may be the cause of myocardial infarction, but it is also the origin of other heart diseases

Younger people are most affected; for women, the average age is about 38 years, for men about 46 years.

The causes of coronary artery dissection are due to the rupture of the walls of a coronary artery

They are made up of 3 layers, called tonaches, which are called: intima, media and adventitia, starting with the innermost and ending with the outermost.

The coronary dissection, will see the laceration of the innermost layer, the intima; the blood will pass inside the ‘laminae’, generated by the sloughing of the vessel, and will flow into the middle tonaca creating the false lumen.

It is rare for aortic dissection to have serious effects; the shape of the false lumen could lead to an obstruction to flow which, depending on the severity, degree of obstruction, the vessel affected and where it is located, could cause myocardial infarction.

Symptoms include chest pain, which is described as oppressive, in the retrosternal area, at the mouth of the stomach and extending to the arms. If the coronary dissection is on the right, nausea, low blood pressure and vomiting will occur.

It is rare for conditions leading to cardiac arrest to occur, this happens when major coronary arteries such as the origin of the right coronary artery will be affected.

For those affected by coronary artery dissection, there will be changes in the ECG that make a coronarography urgently needed.

The dissection may also be caused by other coronary artery disease and/or Tako-Tsubo syndrome

Generally, treatment of spontaneous coronary artery dissection tends towards spontaneous recanalisation a few weeks after its occurrence.

If, on the other hand, the coronary artery is obstructed by the false lumen, it will be reopened by recourse to angioplasty and in some cases stent implantation.

These are quite complex procedures, in fact one could face irreversible occlusion of the coronary artery or total rupture with consequent perforation, it is therefore an intervention that requires care and the utmost caution.

The pharmacological treatment to be resorted to is not yet completely clear due to the lack of clinical studies, therefore the use of anti-platelet therapies will be recommended.

As mentioned above, coronary artery dissection has a tendency to heal spontaneously.

However, one must take into account the duration of the occlusion and the vessel involved, which in some cases may cause myocardial infarction; the coronary artery will heal recovering its normal appearance, but the muscle tissue will not be able to regenerate and therefore the infarction cannot be avoided.

The worst prognosis will be when there is extensive anterior infarction or when the common trunk and/or ascending aorta are affected.

For those who have undergone coronary artery dissection, there may be episodes of recurrence.

The use of beta-blockers will be helpful in keeping blood pressure values under control and consequently may also reduce the occurrence of recurrences.