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Fibromuscular Dysplasia Review

Fibromuscular dysplasia is a disorder in which the arterial wall is abnormally thickened and fibrosed.

This can result in hemodynamically significant stenosis and most commonly affects the renal arteries and the carotid arteries. Rarely, mesenteric vessels or other arteries can be involved.

Fibromuscular dysplasia is more common in young women. Symptoms include those from hypertension when the renal arteries are involved. Stroke can occur from either uncontrolled hypertension or from involvement of the fibromuscular dysplasia in the carotid arteries.

The characteristic "string of beads" appearance is seen on angiography. Treatment includes percutaneous transluminal angioplasty (PTA) with stenting of either the renal or carotid arteries.

References:

1. Polosky et al. Fibromuscular Dysplasia. Circulation. 2012; 125: e636-e639

2. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine

3. Hurst's the Heart, 13th Edition

A Broader Understanding Of Heart Attack Risks For Women Is Emerging

Over the past decade, spontaneous coronary artery dissection has emerged as a significant cause of heart attacks in women, many of them young and otherwise healthy 

Vermont Business Magazine A volcano overflowing with lava: that's how Vicki Mascareño-Nelson describes the pain in her jaw and chest last year, just days after Valentine's Day. While its root cause was ultimately found to be a medical emergency, her first thought was less surprising: It must be the chocolate. 

"I was eating some fancy leftover Valentine's Day chocolates, and honestly I thought it was aggravating a preexisting problem with my jaw and giving me severe heartburn," says Mascareño-Nelson. "I'm relatively young, healthy and - like a lot of women - I have a high pain tolerance. I mean, I've had two kids. No way I thought this was a heart attack." 

It wasn't until several hours later, when severe fatigue set in, that Mascareño-Nelson made her way to the Emergency Department of University of Vermont Medical Center with the help of her husband. Attending physicians and nurses quickly recognized that she was having a heart attack.  

"It took me a while to accept it," she said. "The entire experience taught me so much about my heart, my body and the unique risks we face as women – things I think more women should know about."

Heart Attack Risks for Women 

Tests later revealed that Mascareño-Nelson experienced a form of heart attack known as spontaneous coronary artery dissection, or SCAD. During SCAD, a tear in the coronary artery blocks or slows the flow of blood to the heart. Often misdiagnosed, SCAD has emerged as a significant cause of heart attacks, especially in women in their 40s and 50s. Anyone can experience a SCAD, though more than 90% of patients are female.

What makes SCAD difficult to diagnose is that many women who experience it don't have the typical risk factors for heart disease. They're often otherwise healthy.  

"Unfortunately, with SCAD, it can happen to anyone," said Sherrie Khadanga, MD, a cardiologist at UVM Medical Center. "That's why it's so important to listen to your body, even if you consider yourself a healthy person, and seek medical attention if you're experiencing symptoms of a heart attack. Don't take your heart for granted." 

Dr. Khadanga supported Mascareño-Nelson as she healed and began her recovery. Like many people recovering from a SCAD heart attack, surgical repair was deemed risky for Mascareño-Nelson. A combination of rest, medication and cardiac rehabilitation would heal her damaged artery.

"I feel really privileged to be able to have gone to cardiac rehab – it was a game changer for me and helped me indulge my love of snazzy track suits," said Mascareño-Nelson with a laugh. "It helped me to rebuild the mental and physical confidence that I lost because of my heart attack. I know it sounds corny, but it helped me build a relationship with my heart. I'd taken it for granted all those years."

Lessons for Other Women

It was during her recovery that Mascareño-Nelson learned she had two underlying health conditions that likely contributed to the tear in her coronary artery. The first was diagnosed almost immediately at UVM Medical Center: a condition known as fibromuscular dysplasia that causes medium-sized arteries to narrow. Cardiac specialists also later diagnosed her with a condition known as Ehlers-Danlos syndrome, a disorder which affects connective tissues like joints and the walls of blood vessels. Both conditions have been linked to higher risk of SCAD heart attacks. 

"While not definitive, we know that many people that experience SCAD also have these conditions," said Dr. Khadanga. "We also see that extreme stress, whether it be intense physical exercise or severe emotional distress, also increases the risk of a SCAD." 

One year after her heart attack, Mascareño-Nelson is feeling strong again and thinks more needs to be done to educate women about their unique risks and the symptoms of cardiovascular disease. 

"I know that what I've learned from my heart attack could save someone else," said Mascareño-Nelson. "When most people think of a heart attack, they picture someone clutching their left arm in pain – I had no idea that jaw pain or upper back and neck pain are also signs of heart attack. If I had known this, I probably would have gone to the emergency room right away. Hopefully, someone else can learn from my experience." 

About the University of Vermont Medical CenterThe University of Vermont Medical Center  is a 499-bed tertiary care regional referral center providing advanced care to approximately 1 million residents in Vermont and northern New York. Together with our partners at the Larner College of Medicine at the University of Vermont and the College of Nursing and Health Sciences, we are Vermont's academic medical center. The University of Vermont Medical Center also serves as a community hospital for approximately 150,000 residents in Chittenden and Grand Isle counties. 

The University of Vermont Medical Center is a member of The University of Vermont Health Network, an integrated system established to deliver high-quality academic medicine to every community we serve.

For more information visit www.UVMHealth.Org/MedCenter or visit our Facebook, Twitter, YouTube, and blog sites at www.UVMHealth.Org/MedCenterSocialMedia.       

About The University of Vermont Health NetworkThe University of Vermont Health Network is an integrated system serving the residents of Vermont and northern New York with a shared mission: working together, we improve people's lives.  The partners are:

Source: Burlington, VT (2/25/2025) – The University of Vermont Health Network UVMHealth.Org

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