Spontaneous coronary artery dissection differential diagnosis

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Spontaneous Coronary Artery Dissection Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Spontaneous coronary artery dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Angiography

CT

MRI

Echocardiography

Other Imaging Findings

Other Diagnostic Studies

Treatment

Treatment Approach

Medical Therapy

Percutaneous Coronary Intervention

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Type 1

Type 2A

Type 2B

Type 3

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2]

Synonyms and keywords: SCAD

Overview

Spontaneous coronary artery dissection should be differentiated from other causes of acute coronary syndrome. Features suggestive of spontaneous coronary artery dissection include myocardial infarction in young women (age ≤50), absence of traditional cardiovascular risk factors, little or no evidence of coronary atherosclerosis, peripartum state, history of fibromuscular dysplasia, and history of connective tissue disorder or systemic inflammatory disorder.

Differential Diagnosis

Albeit an infrequent condition, spontaneous coronary artery dissection (SCAD) should be included in the differential diagnosis of acute coronary syndrome, particularly among young women with risk factors such as vasculopathy, pregnancy, connective tissue disorder, systemic inflammation, strenuous exercise, emotional stress, or recreational drug use. While demographic and angiographic characteristics may be useful in differentiating SCAD from other causes of myocardial ischemia, intracoronary imaging such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) may be required for establishing a definitive diagnosis.


===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===[1][2][3][4][5][6]





Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3
STEMI Chest discomfort radiated to arms, neck, back, jaw Shortness of breath, dizziness, faintness Nausea, vomiting, sweating Tachycardia, bradycardia Hypertension, hypotension, syncope S4 heart sound, rale, holosystolic murmur in apex Troponin I, T Creatin kinase MB (CKMB) C-reactive protein, BNP Occlusive coronary thrombus formation superimposed on a ruptured or eroded atherosclerotic plaque Coronary angiography
Spontaneous coronary artery dissection Chest discomfort radiated to arms, neck, back, jaw Shortness of breath, dizziness, faintness Nausea, vomiting, sweating Tachycardia, bradycardia Hypertension, hypotension, syncope rale, holosystolic murmur in apex Troponin I, T Creatin kinase MB (CKMB) Coronary angiography intravascular ultrasound (IVUS), optical coherence tomography (OCT) Coronary CT angiography Separation of the coronary artery wall layers, intramural space (false lumen), communicating with the true lumen via intimal tear (flap fenestration), myoendothelial tissue lamina (intimomedial flap) dividing the two vascular spaces, haemorrhage within the tunica media and adventitia Intracoronary imaging such as intravascular ultrasound (IVUS), optical coherence tomography (OCT) Mimicing ECG changes of STMI
Coronary vasospasm Chest discomfort radiated to arms, neck, back, jaw Shortness of breath, dizziness, faintness Nausea, vomiting, sweating Tachycardia, bradycardia Hypertension, hypotension, syncope Rale, holosystolic murmur in apex Troponin I, T Creatin kinase MB (CKMB) morphologic changes in the artery at the site of the spasm, endothelium damaged, Platelets aggregation at this site releasing vasoactive substances, thrombin formation occurring most often from midnight to early morning, Mimicing ECG changes of STMI
Diseases symptom1 symptom2 symptom3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3 Histopathology Gold standard Additional findings
Differential Diagnosis 4
Differential Diagnosis 5
Differential Diagnosis 6

References

  1. Paulo, Manuel; Sandoval, Jorge; Lennie, Vera; Dutary, Jaime; Medina, Miguel; Gonzalo, Nieves; Jimenez-Quevedo, Pilar; Escaned, Javier; Bañuelos, Camino; Hernandez, Rosana; Macaya, Carlos; Alfonso, Fernando (2013). "Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection". JACC: Cardiovascular Imaging. 6 (7): 830–832. doi:10.1016/j.jcmg.2013.02.010. ISSN 1936-878X.
  2. Adlam, David; Alfonso, Fernando; Maas, Angela; Vrints, Christiaan; al-Hussaini, Abtehale; Bueno, Hector; Capranzano, Piera; Gevaert, Sofie; Hoole, Stephen P; Johnson, Tom; Lettieri, Corrado; Maeder, Micha T; Motreff, Pascal; Ong, Peter; Persu, Alexandre; Rickli, Hans; Schiele, Francois; Sheppard, Mary N; Swahn, Eva (2018). "European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection". European Heart Journal. 39 (36): 3353–3368. doi:10.1093/eurheartj/ehy080. ISSN 0195-668X.
  3. . doi:10.1136/2Fhrt.53.4.363. Missing or empty |title= (help)
  4. Davies, Michael J. (1996). "The contribution of thrombosis to the clinical expression of coronary atherosclerosis". Thrombosis Research. 82 (1): 1–32. doi:10.1016/0049-3848(96)00035-7. ISSN 0049-3848.
  5. YASUE, Hirofumi; MIZUNO, Yuji; HARADA, Eisaku (2019). "Coronary artery spasm — Clinical features, pathogenesis and treatment —". Proceedings of the Japan Academy, Series B. 95 (2): 53–66. doi:10.2183/pjab.95.005. ISSN 0386-2208.
  6. Shepherd, John T.; Vanhoutte, Paul M. (1985). "Spasm of the Coronary Arteries: Causes and Consequences (the Scientist's Viewpoint)". Mayo Clinic Proceedings. 60 (1): 33–46. doi:10.1016/S0025-6196(12)65280-X. ISSN 0025-6196.