What Is a Coronary Artery Dissection?

A coronary artery dissection is a separation in the layers in the wall of the coronary artery, causing a restriction in bloodflow to the heart. This can cause a myocardial infarction, where limited blood supply reduces oxygenation and begins to starve the heart muscle. The condition can be rapidly fatal if it is not caught in time. Treatment can depend on the extent of the injury to the coronary artery, and may involve medications and surgery.

This condition involves a small tear in the inner layer of the coronary artery, allowing blood to flow in and create a swelling known as a hematoma. As it builds and spreads, it tears the layers apart and can start to cause clotting and blockage in the artery. Cases of Spontaneous Coronary Artery Dissection (SCAD) appear to be more common in women, and may be linked to hormone cycles. Pregnancy can be a risk factor, although the exact connection is not fully understood. In other instances, the condition may be iatrogenic, caused by a medical procedure.

The slow restriction of bloodflow may cause chest pain and irritation which can get worse over time. These may lead the patient to go to the hospital for treatment. Evaluation with medical imaging studies can show a coronary artery dissection and may reveal the extent of the tear. This is important information to have, as it may impact the course of treatment. Large tears with big clots or significant swelling, for example, may be grounds for immediate surgery.

In a coronary bypass surgery, the involved artery can be bypassed to restore the flow of blood to the heart. Another option is to place a stent to hold the artery open and secure the tear. Some patients may just need medications, like anti-clotting agents, to prevent injury to the heart. Follow-up is recommended after a coronary artery dissection to check for signs of recurrence and make sure the current method of control is still effective.

Studies on coronary artery dissection examine patients with this condition, including people who died before they received treatment, in search for connections. This can help researchers find out what causes the condition and what kinds of risk factors might be associated with it. Information about risk factors can help doctors assess patients to determine who might need additional evaluation, and can also lead to preventative medicine, like recommendations for activities patients can use to reduce their chances of developing a coronary artery dissection.