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27-11-2019 | Heart Beat | Uitgave 4/2020 Open Access

Netherlands Heart Journal 4/2020

Epicardial coronary spasm due to endothelial dysfunction after spontaneous coronary artery dissection

Netherlands Heart Journal > Uitgave 4/2020
V. E. Stegehuis, R. M. Dennert, T. P. van de Hoef, J. J. Piek
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12471-019-01354-4) contains supplementary material, which is available to authorized users.
A 70-year-old woman underwent acetylcholine provocation testing for coronary spasm, due to typical angina symptoms and absence of obstructive coronary artery disease (CAD) as revealed by repeat coronary angiography (CAG). She had a previous conservatively treated spontaneous coronary artery dissection (SCAD).
SCAD is considered a rare non-atherosclerotic cause of acute coronary syndrome, treated predominantly conservatively, as revascularisation is associated with complications. The prevalence of SCAD is higher in women (88.5% in a recent study [ 1]). Moreover, women have a higher risk of symptoms and signs of myocardial ischaemia than men, but simultaneously have a 30–50% chance of having non-obstructive coronary artery disease (NOCAD) when undergoing CAG. Both SCAD and NOCAD are underdiagnosed, but awareness of these conditions is nowadays increasing [ 2]. The long-term effects of SCAD are largely unknown.
In the present case, coronary spasm occurred where previously a SCAD was documented (see Fig.  1). This illustrates that SCAD may cause endothelial dysfunction, resulting in angina symptoms. SCAD and NOCAD are characterised by a distinct risk profile, which is significantly different than that of conventional CAD [ 3, 4]. Vigilance for endothelial dysfunction causing angina symptoms is warranted.

Conflict of interest

V.E. Stegehuis, R.M. Dennert, T.P. van de Hoef and J.J. Piek declare that they have no competing interests.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

Extra materiaal
1. Coronary angiography showing spontaneous coronary artery dissection (SCAD) of the distal left anterior descending artery (LAD) in 2014
2. Coronary angiography showing spontaneous coronary artery dissection of the distal LAD in 2014
3. Coronary angiography showing coronary spasm of the distal LAD in 2018, at the location where previously the SCAD was documented
4. Coronary angiography showing recovery of the coronary spasm of the distal LAD after intracoronary administration of nitroglycerin, at the location where previously the SCAD was documented
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