自发性冠状动脉夹层_NEJM音频听写
SpontaneousCoronary-ArteryDissection
Spontaneouscoronary-arterydissection(SCAD)hasemergedasanimportantcauseofmyocardialinfarctioninyoungpersons.SCADisdefinedasaseparationofthelayersofanepicardialcoronary-arterywallbyintramuralhemorrhage,withorwithoutanintimaltear.SCADcanaffectbothsexesacrossthelifespan,beginninginadolescence.However,approximately90%ofpatientswiththisconditionarewomenwhopresentbetween47and53yearsofage.FamilialcasesofSCADhavebeenreported,butmostcasesaresporadic.
SCADisdiagnosedwithangiography.PatientsinwhomSCADisthesuspectedcauseofacutemyocardialinfarctionshouldundergocoronaryangiographytoconfirmthediagnosisanddefinehigh-riskanatomicalfeaturesthatwouldwarrantconsiderationofearlyrevascularization.AccurateandrapiddiagnosisisparamountbecausethemanagementofacutemyocardialinfarctioncausedbySCADdiffersvastlyfromthatofatheroscleroticmyocardialinfarction.SCADcanbeaformefrusteofanunderlyingsystemicarteriopathy—namely,fibromusculardysplasia.
Medicalmanagementispreferredoverattemptsatrevascularization.SCADmaybeafirstmanifestationofanunderlyingsystemicarteriopathy,andthediagnosisandtreatmentofextracoronaryvascularabnormalitiesareimportant