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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 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Type 2A Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Type 2B Case 1 Case 2 Case 3 Case 4 Type 3 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6

Algorithm for the Angiographic Diagnosis and Confirmation of Spontaneous Coronary Artery Dissection

Presence of features that raise the suspicion for SCAD? (click for details) ❑  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 ❑  History of connective tissue disorder or systemic inflammation     ❑  Marfan's syndrome     ❑  Ehlers-Danlos syndrome Type 4     ❑  Loeys-Dietz syndrome     ❑  Cystic medial necrosis     ❑  Systemic lupus erythematosus     ❑  Crohn's disease     ❑  Ulcerative colitis     ❑  Polyarteritis nodosa     ❑  Sarcoidosis     ❑  Churg-Strauss syndrome     ❑  Wegener's granulomatosis     ❑  Rheumatoid arthritis     ❑  Giant cell arteritis

Perform early coronary angiography

Presence of type 1 SCAD lesion characteristics? (click for details) ❑  Contrast staining of arterial wall ❑  Multiple radiolucent lumens ❑  Contrast hang-up or slow clearing from the lumen

YES

NO

Type 1 SCAD most likely

Presence of type 2 SCAD lesion characteristics? (click for details) ❑  Diffuse lesion (typically >20–30 mm) ❑  Smooth luminal narrowing with varying severity ❑  Involvement of mid to distal segments

YES

NO

Stenosis relieved by intracoronary nitroglycerin?

Look for type 3 SCAD lesion characteristics (click for details) ❑  Focal or tubular stenosis (typically <20 mm) ❑  Mimics atherosclerosis ❑  Additional features     ❑  No atherosclerosis in other arteries     ❑  Long lesions (11–20 mm)     ❑  Hazy stenosis     ❑  Linear stenosis

YES

NO

Type 3 SCAD most likely ❑  Consider OCT or IVUS for definitive diagnosis ❑  Reassess with angiography in 4 to 6 weeks

R/O coronary spasm or other conditions

Type 2 SCAD most likely ❑  Consider OCT or IVUS for definitive diagnosis ❑  Reassess with angiography in 4 to 6 weeks