Clinical Presentation, Management and Prognosis of Patients With Spontaneous Coronary Artery Dissection

Pargaonkar, Vedant; Khandelwal, Abha; Krishnan, Gomathi; Sears, Katharine; Hoover, Valerie; Fearon, William F.; Lee, David; Yeung, Alan C.; Tsai, Sandra; Nejedly, Mary; Naderi, Sahar; Tremmel, Jennifer A.

doi:10.1016/s0735-1097(16)30054-7

Cited by 1 publication

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“…A cross-sectional study of 158 patients by Liang et al showed that 33% had received treatment for depression, and 37% for anxiety (83). Another retrospective analysis by Pargaonkar et al reported anxiety disorder (9.8%), major depression (8.4%), and post-traumatic stress disorder (5%) (84). Although current guidelines recommend screening for anxiety and depression after MI, this is often missed in both younger and female cohorts, leaving these patients susceptible to a lack of support and follow up (85).…”

Section: Psychosocial Impact and Supportmentioning

confidence: 99%

Current state-of-play in spontaneous coronary artery dissection

Franke¹,

Wong²,

Baumann

et al. 2019

Cardiovasc. Diagn. Ther

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For over 80 years, spontaneous coronary artery dissection (SCAD) has been recognised as a cause of myocardial infarction. SCAD is described as a non-iatrogenic, non-atherosclerotic coronary artery dissection, resulting in formation of a false lumen or intramural haematoma in the coronary artery wall that compresses the true lumen, often compromising myocardial blood flow. In early literature, the incidence of SCAD in acute coronary syndrome (ACS) was underestimated. Recent advances in awareness and widespread early angiographic investigation in ACS has led to important shifts in our understanding of the prevalence, predisposing causes, natural history, aetiology, clinical and angiographic features, management, and prognosis of SCAD. It is now well understood that SCAD predominantly affects women and is responsible for around 20% of ACS presentations in females below the age of 60. Despite this, SCAD is still often overlooked and misdiagnosed as atherosclerotic disease. Misdiagnosis is multifactorial; with contributing factors including a low clinical index of suspicion, particularly in young females, a lack of clinician familiarity with angiographic variants, and limitations of angiography. Although increasing evidence suggests that optimal management is distinct from atherosclerotic coronary artery disease, many questions remain unanswered regarding the pathogenesis and optimal treatment of SCAD, heralding prospective research to answer these questions. This review aims to give a current clinical perspective on SCAD and highlight the importance of familiarity and vigilance with this condition when diagnosing and treating ACS.

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Section: Psychosocial Impact and Supportmentioning

confidence: 99%