Spontaneous Coronary Artery Dissection and Takotsubo Syndrome: Converging Mechanisms, Diagnostic Pitfalls, and a
Michele Golino1, Khalid Shakfeh1, Ashley A Stiglich2
1Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA.
Insights
Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) can occur together, sharing stress-related causes and diagnostic challenges. Understanding their overlap is key for accurate diagnosis and management in women.
Area of Science:
- Cardiology
- Women's Health
- Pathophysiology
Background:
- Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) are acute coronary syndromes predominantly affecting women.
- Both conditions are frequently triggered by emotional or physical stress.
- Emerging evidence suggests SCAD and TTS may coexist, sharing common pathophysiological mechanisms.
Purpose of the Study:
- To examine the pathophysiological convergence between SCAD and TTS.
- To address the diagnostic complexity when these entities coexist.
- To propose a novel diagnostic algorithm and management guidance.
Main Methods:
- Narrative review of existing literature.
- Analysis of shared pathophysiological pathways (catecholamine-mediated, vascular vulnerability, hormonal influences).
- Development of a stepwise diagnostic algorithm integrating clinical risk stratification, coronary angiography, intracoronary imaging, and cardiac MRI.
Main Results:
- SCAD and TTS share overlapping clinical presentations, leading to diagnostic challenges and potential misdiagnosis.
- Common underlying mechanisms include catecholamine surge, vascular wall abnormalities, and hormonal factors.
- A proposed algorithm aims to improve diagnostic accuracy for coexisting SCAD and TTS.
Conclusions:
- SCAD and TTS are not always distinct entities and frequently overlap, particularly in women.
- Accurate diagnosis requires consideration of shared pathophysiology and advanced imaging techniques.
- Further research is needed to refine management strategies for coexisting SCAD and TTS.
Abstract:
Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) are two conditions presenting as acute coronary syndromes that predominantly affect women and are frequently triggered by emotional or physical stress. While traditionally considered distinct entities, emerging evidence suggests that these conditions may coexist more frequently than previously recognized, sharing common pathophysiological mechanisms centered on catecholamine-mediated pathways, vascular vulnerability, and hormonal influences. Their overlapping presentations create significant diagnostic challenges that may lead to misdiagnosis and suboptimal management. This narrative review examines the pathophysiological convergence between SCAD and TTS, addresses the diagnostic complexity arising when these entities coexist, and proposes a novel stepwise diagnostic algorithm integrating clinical risk stratification, coronary angiography, intracoronary imaging, and cardiac magnetic resonance imaging. The review also provides scenario-dependent management guidance and outlines priorities for future research.
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:30Coronary Artery Disease III: Clinical Manifestations
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies