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The common cause of heart attack in young females…

The common cause of heart attack in young females…

Last Reviewed : 12/30/2020
The common cause of heart attack in young females…

If you are a young female, you will find this piece particularly interesting because it is meant for your social stratification. In the general population, a heart attack is caused due to blockages of blood vessels supplying the heart. These blood vessels are called as coronary arteries. The process of fat deposition causing blockages in coronary arteries is called as atherosclerosis. Atherosclerosis is usually seen in elderly individuals with risk factors like diabetes, high blood pressure, smoking, obesity and high cholesterol. In young females, atherosclerosis is very rare. The most common cause is dissection of the coronary arteries. It was a rare case in the earlier days, but not anymore.Now, due to the use of invasive angiography testing and increased awareness, more cases are being identified in patients presenting in the emergency room with acute chest pain.

Artery dissection is the formation of a tear in blood vessels of the heart that eventually slows down or blocks the blood supply to the heart, resulting in ischemic infarction of the heart. It culminates in heart attack, rhythm abnormalities, and sometimes, sudden cardiac death. To prevent it from happening, diagnose the dissection early and treat it accordingly as the management differs from other causes of the heart attack.

 

Risk factors

Artery dissection is responsible for the heart attack in young females, especially in women below 50 years of age. Though the cause is unknown, the most common risk factors include fibromuscular dysplasia, connective tissue disorders, postpartum, and hormonal problems. Increased stress, intense physical exertion, sympathomimetic drugs (like cocaine), and maneuvers or processes that increase the intra-abdominal pressure worsen shear stress on the coronary arterial wall.

 

Pathophysiology


Spontaneous coronary artery dissection (SCAD) is caused by a tear in the walls of coronary arteries resulting in separation of the inner intimal layer from the outer vessel wall. The mechanism behind the formation of tear is not known yet. SCAD often develops in healthy people who do not have any risk factors for heart disease such as Hypertension or Diabetes mellitus.

The intimal tear leads to the intramural hematoma or a blood clot inside the wall of the blood vessel, which decreases or stops the blood supply to heart muscles, causing heart attack. SCAD should be distinguished from catheter induced and atherosclerotic dissection. Dissection in SCAD is extensive. But then, it is limited in the latter cases owing to the presence of atheroma and calcifications in the vessel wall layers.

 

Clinical presentation

SCAD presents with signs and symptoms of a heart attack. These symptoms are chest pain, radiating to arm, shoulder, and jaw, palpitations, sweating, nausea, dizziness, shortness of breath, and fatigue. It presents on ECG with both ST and non-ST elevated heart attack along with increased troponin levels.

 

 

Management

The diagnosis of SCAD depends on clinical presentation and findings on ECG and other blood tests. Coronary angiography and other imaging techniques help to confirm the diagnosis. It presents with a longitudinal filling defect in the vessel walls on imaging. The main goal of treatment is to restore blood flow to the heart. In most cases, asymptomatic patients are managed conservatively. More so, the patients are left for dissection to heal naturally. In symptomatic individuals, treatment is either medical or surgical.

Treatment is personalized to an individual depending on the size and location of a tear and also on the clinical presentation of an individual. Most of the time, doctors try not to follow invasive procedures. Well, the medications used in SCAD include Aspirin, anticoagulants, anti-hypertensives, other drugs to relieve chest pain and other symptoms. If symptoms do not resolve or recur, the opening of blocked arteries with a stent or balloon can be done. If stent placement fails or dissection involves more than one artery, bypass surgery is done to divert the blood flow and improve circulation to the heart.

More importantly, long term survival is excellent in SCAD patients. But there is an increased risk of future recurrences too. Therefore, it mandates the regular follow-up of patients with coronary angiography as there is no effective treatment to reduce the risk of recurrence.

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