Bröstsmärta hos kvinnor med låg risk för kranskärlssjukdom. Tänk på kranskärlsdissektion
Engelsk titel: Chest pain in women with low risk of coronary disease. Think of coronary artery dissection
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Författare:
Rohman H
;
Lundman P
;
Sarkar N
;
Wallen H
Email: helena.rohman@ds.se
Språk: Swe
Antal referenser: 17
Dokumenttyp:
Fallbeskrivning
UI-nummer: 09121115
Sammanfattning
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. We describe four cases, all women, with few or no apparent risk factors where SCAD was diagnosed upon coronary angiography. This diagnosis should be considered in young or middle-aged women with symptoms of acute coronary syndrome. If SCAD is suspected, medical treatment with platelet inhibitors, beta-blockers and anticoagulating agents should be initiated and coronary angiography should be performed urgently. Medical management, percutaneous coronary intervention as well as surgical revascularisation have been described as management strategies. The treatment of choice depends upon the clinical presentation, anatomic localization of dissection, and the amount of myocardium at risk.
The etiology of SCAD remains unclear although arterial dissections have been associated with Marfan's syndrome, sarcoidosis, angiitis, and connective tissue disorders. A good long-term prognosis is expected if there is limited dissection. Early clinical suspicion and diagnosis improve the prognosis in these patients.