冠状动脉夹层: Not Just a 心脏病
有时, 心脏病 is the result of spontaneous tearing in the coronary artery wall.
The artery wall has three layers 和 when a tear occurs, blood can pass through the innermost layer 和 become trapped 和 bulge inward. This narrows or blocks the artery 和 can cause a 心脏病 because blood flow can’t reach the heart muscle. When this type of tear happens without warning, it’s called spontaneous coronary artery dissection (SCAD).
Researchers aren’t sure what causes SCAD, but patients are often women who are otherwise healthy, with few or no risk factors for heart disease. Scientists think it’s likely that multiple factors may cause SCAD, such as abnormalities in the arteries, 遗传学, hormonal influences or inflammatory issues. These may be made worse by stressors in a person’s environment.
Recent studies have also shown many SCAD patients also have fibromuscular dysplasia, a condition that causes abnormal cell growth in the arteries that can cause narrowing, beading or tearing in the artery walls, or 动脉瘤.
Physical or emotional stress are commonly reported to have happened before SCAD. Emotional stressors have been reported more in women. Physical stressors such as isometric exercise 和 lifting weights have more often occurred before SCAD in men.
Though SCAD can happen in men 和 people of nearly any age, it occurs overwhelmingly in women in their 40s 和 50s. 这可能会导致 急性冠状动脉综合征 in up to 35% of 心脏病s in women 50 和 under. And though pregnancy-related SCAD makes up a small percentage of all SCAD cases, it’s the most common cause of 心脏病s during pregnancy.
Although SCAD can cause a life-threatening 心脏病, SCAD patients don’t typically have other heart disease risk factors. 这就是为什么认识到 心脏病发作的症状 对SCAD患者至关重要吗. 警告信号可能包括 胸部疼痛 or pressure, shortness of breath, profuse sweating 和 dizziness.
Treatment for SCAD patients may differ from other 心脏病 patients, who may require a procedure to insert a 支架 to hold the artery open or bypass surgery. More conservative therapy that emphasizes blood pressure control 和 medication 会有更好的结果. For patients who are unstable with ongoing signs of a 心脏病, 支架 placement or bypass surgery may be used.
Health care professionals may recognize the signs of SCAD using an 血管造影(PDF), but an intravascular ultrasound or optical coherence tomography screening that allows doctors to see the artery from the inside out makes it easier to see. However, those tests are not as readily available as an angiogram.
SCAD patients have a high risk of recurrence 和 should let their health care team know about changes to their health. They should also make sure they’re reducing other risks for heart disease, such as 高血压, 吸烟 or 高胆固醇.
Dr. Naesha Parks began her journey with SCAD in 2008, just ten days after giving birth to her son. Her doctors discovered that she had a coronary artery dissection which required open heart surgery. 下面是她的故事:
