Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Spontaneous Coronary Artery Dissection Treated Conservatively in a Non-pregnant Patient: A Case Report

Jonathan Francois, Sostanie Takota Enoru, Joseph Casillas, Dommalur Jayaranagaiah, Pramod Theetha Kariyanna, Ishmam Ibtida, Moro O. Salifu, Samy I. McFarlane*

Department of Internal Medicine, SUNY-Downstate-Health Science University, Brooklyn, New York, United States- 11203

Abstract: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (MI) and it is greatly misdiagnosed. If not recognized, SCAD carries a high in-hospital mortality rate. It is most commonly seen in females during the peripartum period, individuals with atherosclerotic disease and/or connective tissue disorders. In this report we present a case of 55 years old non-pregnant female without history coronary artery disease (CAD), who presented with squeezing chest pain, ST segment elevation on electrocardiogram (ECG) and negative cardiac markers. Subsequently coronary angiogram (CAG) revealed dissection of the left anterior descending artery (LAD) with 100% stenosis. Due to high risk of perforation it was decided to treat the patient conservatively and subsequently she was discharged home with no complications. In this report, we demonstrated that early recognition of SCAD and conservative management, in a non-pregnant patient, can lead to decreases in-hospital complications and favorable outcomes.

Keywords: spontaneous coronary dissection, acute coronary syndrome, non-pregnant female

Received April 20, 2020; Revised May 22, 2020; Accepted May 29, 2020

Citation: Jonathan Francois, Sostanie Takota Enoru, Joseph Casillas, Dommalur Jayaranagaiah, Pramod Theetha Kariyanna, Ishmam Ibtida, Moro O. Salifu, Samy I. McFarlane, Spontaneous Coronary Artery Dissection Treated Conservatively in a Non-pregnant Patient: A Case Report. American Journal of Medical Case Reports, 8 (9). 274-276. January 2020. doi:10.12691/ajmcr-8-9-5

1. Introduction

SCAD is defined as non-traumatic and non-iatrogenic separation of the coronary arterial wall [1]. It is predominantly seen in younger women without any risk factors for coronary heart disease. It is largely under-reported and a fatal cause of Acute Coronary Syndrome (ACS) [2]. Although the prevalence and incidence of this condition remains unclear, it is estimated to contribute to 1.7-4% of ACS [3,4]. Additionally, SCAD may be the cause of 0.5% of sudden cardiac deaths [5]. The first SCAD case documented was in 1931, where a 42-year old woman, otherwise healthy, suddenly died after a violent retching attack [6]. This condition is increasingly being considered as a pertinent etiology of myocardial infarction among young women.

We understand SCAD MI to be defined as a lack of myocardial blood flow due to partial or complete occlusion of the coronary artery from a vessel-wall tear and/or hematoma [7]. Spontaneous coronary artery dissection make up 24-36% of MIs in women <50 years and is a common cause of MI during pregnancy [8].

2. Case Presentation

A 55-year-old female with a past medical history of chronic hepatitis C, opiate abuse disorder, anxiety and recurrent chest pain status post multiple coronary angiograms presented to the ED with a sudden onset of substernal, squeezing-like, non-radiating chest pain associated with diaphoresis and shortness of breath. She reported to have had similar chest pains in the past anddenied a family history of sudden cardiac death and cardiovascular disease. She admitted crack-cocaine abuse in the past, butdenied any cigarette use. On presentation, the patient's vitals were stable and her physical examination was unremarkable. Her initial ECG was significant for ST-segment elevations in V1-V3 and ST depressions in III and aVF (Figure 1). Initial troponins were negative and the remaining labs were unremarkable. As a result, in the ED she received aspirin 162mg, Plavix 600mg and Heparin drip.

An emergent CAG was performed that revealed 100% stenosis of the left anterior descending artery (LAD) in the middle third of the vessel caused by a spontaneous dissection (Figure 2a/2b). There was also 90% stenosis in the proximal third of the 1st septal (S1) likely due to a spontaneous dissection. The left circumflex and right coronary artery were patent and free of disease. It was decided to treat the dissection with conservative management as the risks of perforation and further dissection outweighed the benefits. Left ventriculogram revealed an ejection fraction of 62% with anterior hypokinesis and apical akinesis. A year ago, the patient presented to another hospital center with chest pain and subsequently underwent a CAG which showed normal S1 and LAD.

The patient was observed under Coronary Care Unit (CCU), with no further chest pain episodes, telemetry events or rising in cardiac markers. Transthoracic echocardiogram a day after the procedure showed anterior, anteroseptal, apical and distal inferior hypokinesis with left ventricular ejection fraction of 40%. The patient was treated with dual antiplatelet therapy (aspirin and clopidogrel), metoprolol and sacubitril/valsartan. She was discharged home in stable condition.

Figure 1. EKG on presentation, showing ST elevation over the anteroseptal leads (V1-V4) and ST depressions over the inferior leads (III-aVF)

Figure 2. a (left) Left Coronary Artery (LCA) in Right Anterior Oblique (RAO) Cranial - the arrows locate the remnant of the LAD. b (right) LCA, showing the probably dissected S1 and the Left Anterior Descending (LAD) remnant

3. Discussion

The pathophysiology of SCAD is unknown, one hypothesis points to direct damage to the vasa vasorum leading to intermedial hemorrhage [9]. It is most commonly seen in females during the peripartum period, individuals with atherosclerotic disease and/or connective tissue disorders. It is a rare cause of ACS, but one that every health professional should be aware of. The diagnosis is made by CAG, but if this is inconclusive one can use intravascular ultrasound (IVUS) and more recently optical coherence tomography (OCT) to confirm the diagnosis [10]. There is no standard approach for the management of SCAD. Although Percutaneous coronary intervention (PCI) is a common practice in many of these cases, it remains a challenging decision due to the fragility of the vessel wall during the dissection. Thrombolytic therapy should be avoided as it can cause extension of the ongoing dissection [11]. For this reason, if the patient is hemodynamically stable and there is no sign of ongoing ischemia, the first line therapy is conservative management [12]. In our case it was decided to proceed with the latter, given that our patient was stable with no active chest pain during the CAG. This case proves that once again conservative management may lead to better outcomes when compared to aggressive measures like PCI or Coronary Artery Bypass Graft (CABG). In conclusion, more data and further studies are needed to standardize treatment of SCAD in non-pregnant patients, but early identification of SCAD as a cause of MI is imperative to reduce mortality and maximize better outcomes.

Acknowledgements

This work is supported, in part, by the efforts of Dr. Moro O. Salifu M.D., M.P.H., M.B.A., M.A.C.P., Professor and Chairman of Medicine through NIH Grant number S21MD012474.

References

[1]   | Taha M, Latt H, Al-Khafaji J, Ali M, Seher R. A case of spontaneous coronary artery dissection presenting with acute anterior wall myocardial infarction in a young adult male - an increasingly recognized rare disease. J Community Hosp Intern Med Perspect. 2018; 8(2): 60-63. Published 2018 Apr 17.
[2]   | Lebrun, S., & Bond, R. M. (2018). Spontaneous coronary artery dissection (SCAD): The underdiagnosed cardiac condition that plagues women. Trends in Cardiovascular Medicine, 28(5), 340-345.
[3]   | Rashid HN, Wong DT, Wijesekera H, Gutman SJ, Shanmugam VB, Gulati R, et al. Incidence and characterisation of spontaneous coronary artery dissection as a cause of acute coronary syndrome—a single-centre Australian experience. Int J Cardiol 2016; 202: 336-8.
[4]   | Nishiguchi T, Tanaka A, Ozaki Y, Taruya A, Fukuda S, Taguchi H, et al. Prevalence of spontaneous coronary artery dissection in patients with acute coronary syndrome. Eur Heart J Acute Cardiovasc Care 2016; 5: 263-70.
[5]   | Hill SF, Sheppard MN. Non-atherosclerotic coronary artery disease associated with sudden cardiac death. Heart 2010; 96: 1119-25.
[6]   | Pretty H. Dissecting aneurysm of coronary artery in a woman aged 42. Br Med J 1931; 1: 667.
[7]   | Tweet MS, Kok SN, Hayes SN. Spontaneous coronary artery dissection in women: What is known and what is yet to be understood. Clin Cardiol. 2018; 41(2): 203-210.

[8]  
Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, Ganesh SK, Gulati R, Lindsay ME, Mieres JH, Naderi S, Shah S, Thaler DE, Tweet MS, Wood MJ.; American Heart Association Council on Peripheral Vascular Disease; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Genomic and Precision Medicine; Stroke Council. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation 2018; 137: e523-e557.

[9]   | Spontaneous coronary artery dissection: new insights from the tip of the iceberg? Alfonso F. Circulation. 2012; 126: 667.
[10]   | A case report of spontaneous coronary artery dissection and the role of intravascular imaging for accurate diagnosis and successful management. Chen CC, Liu JC, Sung LC, et al. Medicine (Baltimore) 2019; 98: 14112.
[11]   | Shamloo BK, Chintala RS, Nasur A, et al. Spontaneous coronary artery dissection: aggressive vs. conservative therapy. J Invasive Cardiol 2010; 22: 222-8.
[12]   | Jinnouchi H, Sakakura K, Matsuda J, Wakabayashi Y, Wada H, Momomura S, et al. Recurrent spontaneous coronary artery dissection observed with multiple imaging modalities. Int Heart J 2013; 54: 182-3.