What Clinicians Should Know Αbout Spontaneous Coronary Artery Dissection

Abstract

Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome and sudden death in young persons, particularly women. Associated conditions include fibromuscular dysplasia, peripartum status, and episodes of extreme emotion or exercise. Because of heightened awareness and improved diagnostic accuracy, it is increasingly important for clinicians to understand SCAD. Moreover, short-term and long-term management strategies diverge from typical strategies for atherosclerotic disease. In this Concise Review, we aim to highlight the key points about SCAD, including presentation, diagnosis, associated conditions, and short-term and long-term management.

A nationwide evaluation of spontaneous coronary artery dissection in pregnancy and the puerperium

“…Migraine has been reported previously as a risk factor for MI13 and we also observed an association with SCAD. It has been proposed by several authors that stressful events and depression might be associated with the development of SCAD1 6 16 and our study affirms this finding (figure 1). …”

“…Clinical findings that can lead to the diagnosis of SCAD include abnormal electrocardiographic findings, elevated cardiac biomarkers and regional wall motion abnormalities on echocardiography 6. As the typical patient is often young and healthy with no identified cardiovascular risk factors, SCAD may not be considered in the preliminary differential diagnosis 6. A higher index of suspicion and knowledge about this condition are prerequisites to an earlier and appropriate diagnosis of SCAD.…”

Spontaneous coronary artery dissection in women: What is known and what is yet to be understood

“…The most commonly affected coronary vessel is the left anterior descending coronary artery, although any of the coronary arteries and branches can be affected. 9 In 9% to 18% of cases, SCAD is present in >1 coronary artery at presentation, which is referred to as multivessel SCAD. 3,5–8,12 …”

Spontaneous right coronary artery dissection

“…Given the possibility of early dissection progression, a 5-day inpatient-monitoring period is prudent 5. Antiplatelet therapy and beta-blockers should be administered, with the addition of statins and angiotensin-converting enzyme inhibitors in cases of hyperlipidemia and left ventricular dysfunction, respectively.…”

“…Furthermore, patients with SCAD frequently have concurrent extracoronary vascular pathology, including dissection, aneurysm and fibromuscular dysplasia. There is a role for non-invasive, comprehensive vascular imaging with CT angiogram, both for screening and post treatment surveillance 5. In addition, counselling regarding pregnancy and medical genetics is recommended 7.…”