Spontaneous coronary artery dissection differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Spontaneous coronary artery dissection}}
{{Spontaneous coronary artery dissection}}
{{CMG}}; {{AE}}{{AKK}}
{{CMG}}; {{AE}} {{Sara.Zand}} {{AKK}}


{{SK}} SCAD
{{SK}} SCAD
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==Differential Diagnosis==
==Differential Diagnosis==
Albeit an infrequent condition, [[spontaneous coronary artery dissection]] ([[SCAD]]) should be included in the differential diagnosis of [[acute coronary syndrome|acute coronary syndrome]], particularly among young [[women]] with [[risk factors]] such as [[vasculopathy]], [[pregnancy]], [[connective tissue disorder]], [[systemic inflammation]], [[exercise|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|intravascular ultrasound]] ([[IVUS]]) and [[optical coherence tomography|optical coherence tomography]] ([[OCT]]) may be required for establishing a definitive diagnosis.
===Differentiating [[spontaneous coronary artery dissection]] from other diseases ===
<ref name="PauloSandoval2013">{{cite journal|last1=Paulo|first1=Manuel|last2=Sandoval|first2=Jorge|last3=Lennie|first3=Vera|last4=Dutary|first4=Jaime|last5=Medina|first5=Miguel|last6=Gonzalo|first6=Nieves|last7=Jimenez-Quevedo|first7=Pilar|last8=Escaned|first8=Javier|last9=Bañuelos|first9=Camino|last10=Hernandez|first10=Rosana|last11=Macaya|first11=Carlos|last12=Alfonso|first12=Fernando|title=Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection|journal=JACC: Cardiovascular Imaging|volume=6|issue=7|year=2013|pages=830–832|issn=1936878X|doi=10.1016/j.jcmg.2013.02.010}}</ref><ref name="AdlamAlfonso2018">{{cite journal|last1=Adlam|first1=David|last2=Alfonso|first2=Fernando|last3=Maas|first3=Angela|last4=Vrints|first4=Christiaan|last5=al-Hussaini|first5=Abtehale|last6=Bueno|first6=Hector|last7=Capranzano|first7=Piera|last8=Gevaert|first8=Sofie|last9=Hoole|first9=Stephen P|last10=Johnson|first10=Tom|last11=Lettieri|first11=Corrado|last12=Maeder|first12=Micha T|last13=Motreff|first13=Pascal|last14=Ong|first14=Peter|last15=Persu|first15=Alexandre|last16=Rickli|first16=Hans|last17=Schiele|first17=Francois|last18=Sheppard|first18=Mary N|last19=Swahn|first19=Eva|title=European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection|journal=European Heart Journal|volume=39|issue=36|year=2018|pages=3353–3368|issn=0195-668X|doi=10.1093/eurheartj/ehy080}}</ref><ref>{{cite journal|doi=10.1136/2Fhrt.53.4.363}}</ref><ref name="Davies1996">{{cite journal|last1=Davies|first1=Michael J.|title=The contribution of thrombosis to the clinical expression of coronary atherosclerosis|journal=Thrombosis Research|volume=82|issue=1|year=1996|pages=1–32|issn=00493848|doi=10.1016/0049-3848(96)00035-7}}</ref><ref name="YASUEMIZUNO2019">{{cite journal|last1=YASUE|first1=Hirofumi|last2=MIZUNO|first2=Yuji|last3=HARADA|first3=Eisaku|title=Coronary artery spasm — Clinical features, pathogenesis and treatment —|journal=Proceedings of the Japan Academy, Series B|volume=95|issue=2|year=2019|pages=53–66|issn=0386-2208|doi=10.2183/pjab.95.005}}</ref><ref name="ShepherdVanhoutte1985">{{cite journal|last1=Shepherd|first1=John T.|last2=Vanhoutte|first2=Paul M.|title=Spasm of the Coronary Arteries: Causes and Consequences (the Scientist's Viewpoint)|journal=Mayo Clinic Proceedings|volume=60|issue=1|year=1985|pages=33–46|issn=00256196|doi=10.1016/S0025-6196(12)65280-X}}</ref><ref name="KoyamaYamagishi1995">{{cite journal|last1=Koyama|first1=Jun|last2=Yamagishi|first2=Masakazu|last3=Tamai|first3=Jun|last4=Kawano|first4=Shigeo|last5=Daikoku|first5=Satoshi|last6=Miyatake|first6=Kunio|title=Comparison of vessel wall morphologic appearance a sites of focal and diffuse coronary vasospasm by intravascular ultrasound|journal=American Heart Journal|volume=130|issue=3|year=1995|pages=440–445|issn=00028703|doi=10.1016/0002-8703(95)90349-6}}</ref><ref name="MiyaoKugiyama2000">{{cite journal|last1=Miyao|first1=Yuji|last2=Kugiyama|first2=Kiyotaka|last3=Kawano|first3=Hiroaki|last4=Motoyama|first4=Takeshi|last5=Ogawa|first5=Hisao|last6=Yoshimura|first6=Michihiro|last7=Sakamoto|first7=Tomohiro|last8=Yasue|first8=Hirofumi|title=Diffuse intimal thickening of coronary arteries in patients with coronary spastic angina|journal=Journal of the American College of Cardiology|volume=36|issue=2|year=2000|pages=432–437|issn=07351097|doi=10.1016/S0735-1097(00)00729-4}}</ref><ref name="TweetGulati2016">{{cite journal|last1=Tweet|first1=Marysia S.|last2=Gulati|first2=Rajiv|last3=Williamson|first3=Eric E.|last4=Vrtiska|first4=Terri J.|last5=Hayes|first5=Sharonne N.|title=Multimodality Imaging for Spontaneous Coronary Artery Dissection in Women|journal=JACC: Cardiovascular Imaging|volume=9|issue=4|year=2016|pages=436–450|issn=1936878X|doi=10.1016/j.jcmg.2016.01.009}}</ref><ref name="BulluckDharmakumar2018">{{cite journal|last1=Bulluck|first1=Heerajnarain|last2=Dharmakumar|first2=Rohan|last3=Arai|first3=Andrew E.|last4=Berry|first4=Colin|last5=Hausenloy|first5=Derek J.|title=Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction|journal=Circulation|volume=137|issue=18|year=2018|pages=1949–1964|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.030693}}</ref><ref>{{cite journal|doi=10.1016/j.carreu.2020.09.032}}</ref>


{{details|acute coronary syndromes#Differential Diagnosis|differential diagnosis of acute coronary syndrome}}


Albeit an infrequent condition, spontaneous coronary artery dissection (SCAD) should be included in the differential diagnosis of [[acute coronary syndrome|acute coronary syndrome]], particularly among young women with risk factors such as [[vasculopathy]], [[pregnancy]], [[connective tissue disorder]], [[systemic inflammation]], [[exercise|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|intravascular ultrasound (IVUS)]] and [[optical coherence tomography|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]===<ref name="PauloSandoval2013">{{cite journal|last1=Paulo|first1=Manuel|last2=Sandoval|first2=Jorge|last3=Lennie|first3=Vera|last4=Dutary|first4=Jaime|last5=Medina|first5=Miguel|last6=Gonzalo|first6=Nieves|last7=Jimenez-Quevedo|first7=Pilar|last8=Escaned|first8=Javier|last9=Bañuelos|first9=Camino|last10=Hernandez|first10=Rosana|last11=Macaya|first11=Carlos|last12=Alfonso|first12=Fernando|title=Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection|journal=JACC: Cardiovascular Imaging|volume=6|issue=7|year=2013|pages=830–832|issn=1936878X|doi=10.1016/j.jcmg.2013.02.010}}</ref><ref name="AdlamAlfonso2018">{{cite journal|last1=Adlam|first1=David|last2=Alfonso|first2=Fernando|last3=Maas|first3=Angela|last4=Vrints|first4=Christiaan|last5=al-Hussaini|first5=Abtehale|last6=Bueno|first6=Hector|last7=Capranzano|first7=Piera|last8=Gevaert|first8=Sofie|last9=Hoole|first9=Stephen P|last10=Johnson|first10=Tom|last11=Lettieri|first11=Corrado|last12=Maeder|first12=Micha T|last13=Motreff|first13=Pascal|last14=Ong|first14=Peter|last15=Persu|first15=Alexandre|last16=Rickli|first16=Hans|last17=Schiele|first17=Francois|last18=Sheppard|first18=Mary N|last19=Swahn|first19=Eva|title=European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection|journal=European Heart Journal|volume=39|issue=36|year=2018|pages=3353–3368|issn=0195-668X|doi=10.1093/eurheartj/ehy080}}</ref><ref>{{cite journal|doi=10.1136/2Fhrt.53.4.363}}</ref><ref name="Davies1996">{{cite journal|last1=Davies|first1=Michael J.|title=The contribution of thrombosis to the clinical expression of coronary atherosclerosis|journal=Thrombosis Research|volume=82|issue=1|year=1996|pages=1–32|issn=00493848|doi=10.1016/0049-3848(96)00035-7}}</ref><ref name="YASUEMIZUNO2019">{{cite journal|last1=YASUE|first1=Hirofumi|last2=MIZUNO|first2=Yuji|last3=HARADA|first3=Eisaku|title=Coronary artery spasm — Clinical features, pathogenesis and treatment —|journal=Proceedings of the Japan Academy, Series B|volume=95|issue=2|year=2019|pages=53–66|issn=0386-2208|doi=10.2183/pjab.95.005}}</ref><ref name="ShepherdVanhoutte1985">{{cite journal|last1=Shepherd|first1=John T.|last2=Vanhoutte|first2=Paul M.|title=Spasm of the Coronary Arteries: Causes and Consequences (the Scientist's Viewpoint)|journal=Mayo Clinic Proceedings|volume=60|issue=1|year=1985|pages=33–46|issn=00256196|doi=10.1016/S0025-6196(12)65280-X}}</ref>




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|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[STEMI]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[STEMI]]
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] radiated to [[arms]], [[neck]], [[back]], [[jaw]]
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] with radiation to [[arms]], [[neck]], [[back]], [[jaw]]
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faintness]]
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faint]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[bradycardia]]
| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[bradycardia]]
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| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
| style="background: #F5F5F5; padding: 5px;" |↑[[C-reactive protein]], [[BNP]]
| style="background: #F5F5F5; padding: 5px;" |↑[[C-reactive protein]], [[BNP]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Cardiac]] [[magnetic resonance imaging]] ([[CMR]]): [[myocardial edema]], [[microvascular obstruction]], [[intramyocardial hemorrhage]], [[MI]] size
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Intravascular imaging during [[PCI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Occlusive [[coronary]] [[thrombus]] formation superimposed on a ruptured or eroded [[atherosclerotic]] plaque
| style="background: #F5F5F5; padding: 5px;" |Occlusive [[coronary]] [[thrombus]] formation superimposed on a ruptured or eroded [[atherosclerotic]] plaque
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|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spontaneous coronary artery dissection]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spontaneous coronary artery dissection]]
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] radiated to [[arms]], [[neck]], [[back]], [[jaw]]
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] with radiation to [[arms]], [[neck]], [[back]], [[jaw]]
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faintness]]
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faintness]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
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| style="background: #F5F5F5; padding: 5px;" |[[intravascular ultrasound]] ([[IVUS]]), [[optical coherence tomography]] ([[OCT]])
| style="background: #F5F5F5; padding: 5px;" |[[intravascular ultrasound]] ([[IVUS]]), [[optical coherence tomography]] ([[OCT]])
| style="background: #F5F5F5; padding: 5px;" | [[Coronary CT angiography]]
| style="background: #F5F5F5; padding: 5px;" | [[Coronary CT angiography]]
| style="background: #F5F5F5; padding: 5px;" |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]]
| style="background: #F5F5F5; padding: 5px;" |'''[[Intimal]] [[tear]]''', [[medial dissection]], [[hemorrhage formation]], [[false lumen]] formation.'''[[Hematoma ]]''' formation in [[media]], separation of two arterial layers, formation of false [[lumen]], dissection of the true [[lumen]]  
| style="background: #F5F5F5; padding: 5px;" |[[Intracoronary imaging]] such as [[intravascular ultrasound]] ([[IVUS]]), [[optical coherence tomography]] ([[OCT]])
| style="background: #F5F5F5; padding: 5px;" |[[Intracoronary imaging]] such as [[intravascular ultrasound]] ([[IVUS]]), [[optical coherence tomography]] ([[OCT]])
| style="background: #F5F5F5; padding: 5px;" |Mimicing [[ECG]] changes of  [[STMI]]  
| style="background: #F5F5F5; padding: 5px;" |Mimicing [[ECG]] changes of  [[STMI]]  
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Coronary vasospasm]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Coronary vasospasm]]
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] radiated to [[arms]], [[neck]], [[back]], [[jaw]]
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] with radiation to [[arms]], [[neck]], [[back]], [[jaw]]
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faintness]]
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faintness]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
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| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | [[IVUS]] findings: negative [[remodeling]], diffuse [[intima]], thick media, and wrinkles in the internal elastic membrane even in the absence of a significant [[coronary stenosis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | [[Morphologic]] changes in the [[artery]] at the site of the [[spasm]], [[endothelium]] damaged, [[Platelets]] aggregation at this site  releasing [[vasoactive]] substances, [[thrombin]] formation
| style="background: #F5F5F5; padding: 5px;" | [[morphologic]] changes in the [[artery]] at the site of the [[spasm]], [[endothelium]] damaged, [[Platelets]] aggregation at this site  releasing [[vasoactive]] substances, [[thrombin]] formation
| style="background: #F5F5F5; padding: 5px;" |[[Coronary angiography]] and [[spasm]] provocation test  
| style="background: #F5F5F5; padding: 5px;" |[[Coronary angiography]] and [[spasm]] provocation test  
| style="background: #F5F5F5; padding: 5px;" |occurring most often from [[midnight]] to early [[morning]], Mimicing [[ECG]] changes of  [[STMI]]
| style="background: #F5F5F5; padding: 5px;" |occurring most often from [[midnight]] to early [[morning]], Mimicing [[ECG]] changes of  [[STMI]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 
!Diseases
!symptom1
! colspan="1" rowspan="1" |symptom2
!symptom3
!Physical exam 1
! colspan="1" rowspan="1" |Physical exam 2
!Physical exam 3
!Lab 1
!Lab 2
!Lab 3
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6
| style="background: #F5F5F5; padding: 5px;" |
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|}
|}



Latest revision as of 19:41, 10 April 2021

Spontaneous Coronary Artery Dissection Microchapters

Home

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: Sara Zand, M.D.[2] Arzu Kalayci, M.D. [3]

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 spontaneous coronary artery dissection from other diseases

[1][2][3][4][5][6][7][8][9][10][11]







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 with radiation to arms, neck, back, jaw Shortness of breath, dizziness, faint 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 Cardiac magnetic resonance imaging (CMR): myocardial edema, microvascular obstruction, intramyocardial hemorrhage, MI size Intravascular imaging during PCI Occlusive coronary thrombus formation superimposed on a ruptured or eroded atherosclerotic plaque Coronary angiography
Spontaneous coronary artery dissection Chest discomfort with radiation 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 Intimal tear, medial dissection, hemorrhage formation, false lumen formation.Hematoma formation in media, separation of two arterial layers, formation of false lumen, dissection of the true lumen Intracoronary imaging such as intravascular ultrasound (IVUS), optical coherence tomography (OCT) Mimicing ECG changes of STMI
Coronary vasospasm Chest discomfort with radiation 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) IVUS findings: negative remodeling, diffuse intima, thick media, and wrinkles in the internal elastic membrane even in the absence of a significant coronary stenosis Morphologic changes in the artery at the site of the spasm, endothelium damaged, Platelets aggregation at this site releasing vasoactive substances, thrombin formation Coronary angiography and spasm provocation test occurring most often from midnight to early morning, Mimicing ECG changes of STMI

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.
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