Coronary artery manifestations of fibromuscular dysplasia

J Am Coll Cardiol. 2014 Sep 9;64(10):1033-46. doi: 10.1016/j.jacc.2014.07.014.

Abstract

Fibromuscular dysplasia (FMD) involving the coronary arteries is an uncommon but important condition that can present as acute coronary syndrome, left ventricular dysfunction, or potentially sudden cardiac death. Although the classic angiographic "string of beads" that may be observed in renal artery FMD does not occur in coronary arteries, potential manifestations include spontaneous coronary artery dissection, distal tapering or long, smooth narrowing that may represent dissection, intramural hematoma, spasm, or tortuosity. Importantly, FMD must be identified in at least one other noncoronary arterial territory to attribute any coronary findings to FMD. Although there is limited evidence to guide treatment, many lesions heal spontaneously; thus, a conservative approach is generally preferred. The etiology is poorly understood, but there are ongoing efforts to better characterize FMD and define its genetic and molecular basis. This report reviews the clinical course of FMD involving the coronary arteries and provides guidance for diagnosis and treatment strategies.

Keywords: acute coronary syndrome; coronary vessel anomalies; fibromuscular dysplasia; left ventricular dysfunction; myocardial infarction.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Coronary Syndrome / etiology
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / physiopathology
  • Adult
  • Cause of Death*
  • Coronary Angiography / methods
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / etiology*
  • Coronary Stenosis / mortality
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / pathology
  • Death, Sudden, Cardiac / etiology*
  • Disease Progression
  • Female
  • Fibromuscular Dysplasia / complications*
  • Fibromuscular Dysplasia / diagnosis
  • Fibromuscular Dysplasia / mortality
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology*
  • Myocardial Infarction / mortality
  • Myocardial Infarction / physiopathology
  • Survival Analysis
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / mortality
  • Ventricular Dysfunction, Left / physiopathology