RESUMEN
Spontaneous coronary artery dissection (SCAD) is a poorly understood and under-diagnosed entity of acute coronary syndrome, affecting predominantly young women. Relatively large series have been published in the past five years highlighting this condition, once believed to be rare. Indeed, the pathophysiology, natural history, clinical presentation, patient profile, diagnostic modalities, management and outcomes of SCAD are becoming better understood. The aim of our review is to provide a brief "state of the art" of SCAD in 2016 to help the clinician in the management of this challenging condition.
Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Disección Aórtica/diagnóstico , Aneurisma Coronario/diagnóstico , Adulto , Factores de Edad , Diagnóstico Diferencial , Femenino , Hematoma/diagnóstico , Humanos , Masculino , Factores Sexuales , Tomografía de Coherencia Óptica , Resultado del TratamientoRESUMEN
Spontaneous coronary artery dissection (SCAD) is a poorly understood and under-diagnosed entity of acute coronary syndrome, affecting predominantly young women. On coronary angiography, the diagnosis remains challenging, particularly in case of intramural hematoma without intimal rupture. Intracoronary imaging, especially by optical coherence tomography (OCT), provides an incremental value in terms of diagnosis and management. We report the case of a 49-year-old woman admitted for STEMI caused by an intramural hematoma. In the discussion part, we aim to review the epidemiology, physiopathology, diagnosis, management and long-term prognosis of SCAD.
Asunto(s)
Anomalías de los Vasos Coronarios/diagnóstico , Hematoma/diagnóstico , Infarto del Miocardio/diagnóstico , Tomografía de Coherencia Óptica , Enfermedades Vasculares/congénito , Antagonistas Adrenérgicos beta/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Anticoagulantes/uso terapéutico , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/tratamiento farmacológico , Quimioterapia Combinada , Femenino , Sistema de Conducción Cardíaco/fisiopatología , Hematoma/tratamiento farmacológico , Hematoma/etiología , Humanos , Persona de Mediana Edad , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/etiología , Infarto del Miocardio/fisiopatología , Pronóstico , Factores de Riesgo , Fumar/efectos adversos , Tomografía de Coherencia Óptica/métodos , Resultado del Tratamiento , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/tratamiento farmacológicoRESUMEN
Pseudo-aneurysm of the fibrous continuity zone between the aortic and mitral valves, the so-called "mitral-aortic intervalvular fibrosa" is a rare complication of acute infective endocarditis, rarely after an aortic valve replacement. We report the case of a large pseudo-aneurysm occurred in a 70-year-old man, who had a history of surgical aortic valve replacement 3 years before. There were no biological or clinical evidence for infective acute endocarditis. The originality of this observation can be summarized in three points: the late onset after surgery, the absence of any infectious context and the chronic nature of pseudo-aneurysm, without any complication during a follow-up of 12 months. Transesophageal echocardiography remains the best diagnostic tool.
