Flashcards in 29 - Spontaneous Coronary Artery Dissection Deck (18)
What is spontaneous coronary artery dissection?
Separation of the coronary artery media by hemorrhage with or without an associated intimal teat and isn't associated with aortic root dissection nor is it a consequence of coronary angioplasty or angiography, cardiac surgery or chest trauma
What demographic is most commonly affected by SCAD?
- Occurs most often in young women (age
Which coronary artery is the most frequently involved vessel?
Left anterior descending coronary artery (LAD)
What percent of cases present with multi-vessel dissection?
What is the original presentation of these patients?
- Acute coronary syndrome (ACS)
- Sudden cardiac death (they just die from this)
What is ESSENTIAL in the diagnosis of SCAD?
Early CORONARY ANGIOGRAPHY remains essential in the diagnosis
What other types of imaging provide detailed information on the location and extent of the dissection?
- IVUS (Intravascular ultrasound)
- OCT (Optical coherence tomography)
Describe the treatment of SCAD patients with ongoing myocardial ischemia
Pts w/ ongoing myocardial ischemia must be treated with early revascularization (PCI or CABG)
Describe the treatment of SCAD patients with limited flow
Pts w/o flow limiting dissection should be treated conservatively as spontaneous healing is possible
Do patients with SCAD typically have a high risk profile for coronary artery disease?
No - typically a low coronary risk profile
Not your typical 65 year old obese man with high cholesterol and a smoker
Describe the clinical presentation
- Asymptomatic to unstable angina
- Acute MI
- Ventricular arrhythmias
- Sudden cardiac death
- Asymptomatic and discovered on angiogram
Describe the diagnosis process
- Coronary Angiography
- Intracoronary imaging (IVUS, OCT, MDCT)
- These modalities have helped increase clinical recognition
What would you see on a coronary angiography?
Presence of a thin longitudinal radiolucent line representing intimal medial flap with flow in 2 or more lumens
What is the narrowing caused by?
Narrowing cause by the intramural hematoma imaging on the lumen can be misinterpreted as an atherosclerotic stenosis
When should SCAD be suspected?
In the setting of young women presenting with ACS on angio and no CAD risk factors SCAD should be suspected and IVUS or OCT should be done
What is the prognosis for patients in the hospital with SCAD?
In-hospital mortality of SCAD is relatively low
Mean rate of around 3% (0–4%)
What is the lifetime prognosis for survivors of SCAD?
- Pts who survive the acute phase have a GOOD long term prognosis
- Low recurrence rate of SCAD or ACS and a 95% 2-year survival rate