Spontaneous coronary artery dissection (SCAD): The underdiagnosed cardiac condition that plagues women

Chronic spontaneous coronary artery dissection in association with antiphospholipid syndrome presenting as stable angina

“…SCAD is a condition which predominantly occurs in women with reports of over 90% of patients being women 11 13–15. A prospective study reported the average age of men with SCAD to be 48.6±9.8 years which was less than women at 52.3±9.2 years 16.…”

“…There are few case reports on SCAD in association with systemic inflammatory disease but even fewer with antiphospholipid antibody or antiphospholipid syndrome 3–9. SCAD almost always presents as ACS with elevated cardiac troponin and it predominantly occurs in women with reports of over 90% of patients being women 10–15. We present a rare case of a male patient who had chronic SCAD of the right coronary artery (RCA) which presented as stable angina in association with a known diagnosis of antiphospholipid syndrome.…”

Spontaneous coronary artery dissections and associated predisposing factors: a narrative review

“…SCAD is defined as a spontaneous tear in the coronary arterial wall due to non-atherosclerotic and non-iatrogenic causes [ 1 , 7 , 14 , 15 ]. The underlying pathophysiology of SCAD is multifactorial, related to underlying arteriopathies, inflammation, hormonal factors and mixed connective tissue diseases, whereas the acute event is often preceded by emotional or physical triggers [ 7 ]. Two mechanisms of SCAD are proposed (Fig.…”

“…2 ): first, a spontaneous separation of the coronary arterial wall caused by an intimal tear and resulting in medial dissection, haemorrhage and subsequently the formation of a false lumen [ 15 , 16 ]; second and less often, haematoma formation in the media causing separation of two arterial layers and, thereby, leading to the formation of a false lumen and dissection of the true lumen [ 15 , 16 ]. Coronary blood flow in SCAD is compromised either directly by the intimal tear or indirectly by compression of the medial haematoma on the coronary artery [ 7 , 16 ]. Until now it is uncertain whether a single dominant mechanism causes SCAD or whether both causal events play a role [ 12 ].…”

“…In most cases no or few traditional cardiovascular risk factors are present, although in one third of patients hypertension is reported [ 1 – 3 ]. It is estimated that up to 25% of all ACS in this age group are caused by SCAD, although the diagnosis is often missed [ 2 , 4 – 7 ]. Overall, it is estimated that SCAD accounts for 1.7–4% of all ACS and 0.5% of sudden cardiac deaths [ 4 , 8 , 9 ].…”