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Canadian Journal of Cardiology

Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Cardiomyopathy: A Case Series

Published:March 18, 2015DOI:https://doi.org/10.1016/j.cjca.2015.03.018

      Abstract

      Spontaneous coronary artery dissection (SCAD) and Takotsubo cardiomyopathy (TTC) can both cause myocardial infarction with subsequent normalization of wall motion abnormality. Angiograms of patients with TTC at Vancouver General Hospital were reviewed for SCAD. Clinical and investigational characteristics were recorded. Nine women with nonatherosclerotic SCAD were misdiagnosed as having TTC. Their average age was 55 years. Five patients had hypertension and 4 had emotional or physical stress. Fibromuscular dysplasia was present in 4 women. Wall motion abnormalities corresponded to dissected artery location and subsequently resolved. SCAD should be included in the differential diagnosis of patients suspected of having TTC and coronary angiograms scrutinized for subtle SCAD.

      Résumé

      La dissection spontanée de l’artère coronaire (DSAC) et la cardiomyopathie de Takotsubo (CTT) peuvent toutes deux causer un infarctus du myocarde suivi de la normalisation des anomalies du mouvement de la paroi. Nous avons passé en revue les angiogrammes des patients atteints d’une CTT de l’hôpital général de Vancouver pour rechercher une DSAC. Nous avons noté les caractéristiques cliniques et expérimentales. Neuf femmes ayant une DSAC non athéroscléreuse ont été diagnostiquées à tort comme ayant une CTT. Leur âge moyen était de 55 ans. Cinq patientes souffraient d’hypertension et 4 subissaient un stress émotionnel ou physique. Quatre femmes présentaient une dysplasie fibromusculaire. Les anomalies du mouvement de la paroi correspondaient au siège de l’artère disséquée et ont subséquemment été résolues. Il faudrait inclure la DSAC dans le diagnostic différentiel des patients susceptibles d’avoir une CTT et examiner minutieusement les angiogrammes coronariens pour rechercher une DSAC subtile.
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      Linked Article

      • Reply to Letters From Madias and Y-Hassan—With Regard to “Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Cardiomyopathy: A Case Series”
        Canadian Journal of CardiologyVol. 31Issue 11
        • Preview
          This is in response to the letters from Drs Madias and Y-Hassan on our case series of spontaneous coronary artery dissection (SCAD) misdiagnosed as Takotsubo cardiomyopathy (TTC). There is no universally accepted diagnostic definition for TTC, although the revised Mayo Clinic criteria are most widely accepted,1 and thus adopted in our report. In our series, all patients had underlying SCAD with obstructive coronary stenoses that accounted for the predominant wall motion abnormality, thus, excluding the conventional classic diagnosis of TTC.
        • Full-Text
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      • Takotsubo Syndrome in Patients With Spontaneous Coronary Artery Dissection: Misdiagnosis or a Reality?
        Canadian Journal of CardiologyVol. 31Issue 11
        • Preview
          I greatly enjoyed reading the article by Chou et al.,1 recently published in the Canadian Journal of Cardiology entitled, “Spontaneous Coronary Artery Dissection Misdiagnosed as Takotsubo Syndrome.” The authors described what they called 9 cases of spontaneous coronary artery dissection (SCAD) misdiagnosed as Takotsubo syndrome (TS). I agree with the authors that these patients had SCAD, which had been missed. However, “SCAD misdiagnosed as TS” in those cases needs to be discussed. Our published case,2 commented on by the authors, had left anterior descending (LAD)-SCAD, which induced postischemic myocardial stunning (PIMS).
        • Full-Text
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      • On a Plausible Association of Spontaneous Coronary Artery Dissection and Takotsubo Syndrome
        Canadian Journal of CardiologyVol. 31Issue 11
        • Preview
          I enjoyed reading the study by Chou et al.1 published in the August 2015 issue of the Canadian Journal of Cardiology about the 9 women with nonatherosclerotic spontaneous coronary artery dissection (SCAD), who were misdiagnosed during their hospitalization as having Takotsubo syndrome (TTS). Although the essence of this article is that SCAD could be misdiagnosed as TTS, one could also envisage that SCAD could lead to TTS. Such occurrence of SCAD/TTS comorbidities could be diagnosed on the basis of left ventricular (LV) contrast angiography (or echocardiography) revealing extensive wall motion abnormalities beyond the confines of the area subserved by the coronary artery that has undergone SCAD.
        • Full-Text
        • PDF