title: Coronary artery manifestations of fibromuscular dysplasia.
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.
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, and Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Michelis
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, and Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: jeffrey.olin@mountsinai.org.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Olin
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, and Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Daniella
authors.initials: D
authors.lastname: Kadian-Dodov
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, and Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Valentina
authors.initials: V
authors.lastname: d'Escamard
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, and Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: jason.kovacic@mountsinai.org.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Kovacic
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D000328:Adult; D002423:Cause of Death; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000503:physiopathology
keywords: acute coronary syndrome; coronary vessel anomalies; fibromuscular dysplasia; left ventricular dysfunction; myocardial infarction