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Dr Stéphane Manzo-Silberman (Interventional Cardiologist)
A particular form of infarction, spontaneous dissection of the coronary artery affects rather young patients and represents up to 15% of infarctions in women under 50 years of age. What are the symptoms of this particular heart attack? And how is his treatment going? The answers of Dr Stéphane Manzo-Silberman, cardiologist at the Pitié Salpêtrière APHP cardiology institute and member of the Doctissimo expert committee.
Cardiovascular diseases are the leading cause of death in women. And there is a heart attack that affects young women more, from around 45 years old. This is the spontaneous dissection of the coronary artery.
What is spontaneous coronary artery dissection?
This dissection, which affects a woman in 90% of cases and represents around 5% of infarcts, is caused by a hematoma which forms spontaneously in the wall of the coronary artery and partially or totally obstructs the lumen of the conduit. It can also occur through a tear in the intima, the inner layer of the vessel.
“Spontaneous coronary artery dissection happens as the name suggests spontaneously, unlike iatrogenic dissection, caused during angioplasty“says Dr. Stéphane Manzo-Silberman, cardiologist. “This dissection concerns women and very often young women, around 45, who do not have the traditional cardiovascular risk factors of tobacco, obesity, diabetes or dyslipidemia.“.
What are the signs of a spontaneous coronary artery dissection?
The signs of this dissection are the same as those of a classic infarction: chest tightness, difficulty breathing, palpitations, shortness of breath on exertion or sometimes at rest, persistent fatigue, digestive disorders, nausea … It is important to think about this diagnosis in young women, because the spontaneous dissection of the coronary artery “accounts for up to 15% of heart attacks in women under 50“says Stéphane Manzo-Silberman again.
Without forgetting that the infarction can be diagnosed later in women, especially in the absence of the usual risk factors and when there are many symptoms associated with chest discomfort.
What is the management of this pathology?
According to the cardiologist, the only way to make the diagnosis of this spontaneous dissection of the coronary artery is to do the same examination as for a classic infarction: a coronary angiography. “The examination will show the dissection and will guide the management, whether it is a hematoma or a dissection of the intima, which can be partial or total, moreover.“.
Treatment will depend on the shape of the dissection. “If the flow in the artery is respected, conservative treatment (without angioplasty) is preferable because the patient will heal spontaneously. On the contrary, if the flow in the artery is compromised: it is urgent to restore good reperfusion, a gesture is necessary to restore it“says the specialist again.
In all cases, the patient requires monitoring for several days, four to five on average, in the intensive care unit. “She will then be followed by a cardiologist for the adaptation of her treatments” concludes Dr. Manzo-Silberman.
The impact of genetic risk factors
A study published last May in the journal Nature Genetics and coordinated by Nabila Bouatia-Naji, director of research at Inserm, demonstrated that the risk of spontaneous dissection of the coronary artery can be favored by genetic factors.
The researchers analyzed the DNA of nearly 1,900 coronary dissection patients and compared it with that of 9,300 healthy people. Result: the disease is controlled by a very large number of regions of the genome, which are called loci.
Scientists have demonstrated that 16 individuals represent a quarter of all genetic factors involved in coronary dissection. The majority of them had already been implicated in other diseases – such as fibrodysplasia – but also in the production of molecules linked to the strength of blood vessels.