Spontaneous coronary artery dissection

A rare condition involving a tear in a coronary artery

Spontaneous coronary artery dissection
Synonyms	Coronary artery dissection
Pronounce
Field	Cardiology
Symptoms	Chest pain, shortness of breath, nausea, dizziness, sweating, heart attack
Complications	Myocardial infarction, arrhythmia, sudden cardiac death
Onset	Sudden
Duration	Variable
Types	Type 1, Type 2, and Type 3 (based on angiographic appearance)
Causes	Tear in the coronary artery wall; often idiopathic or related to fibromuscular dysplasia, pregnancy, or hormonal influences
Risks	Female sex, postpartum state, fibromuscular dysplasia, connective tissue disorders, extreme stress
Diagnosis	Coronary angiography, intravascular ultrasound (IVUS), optical coherence tomography (OCT)
Differential diagnosis	Atherosclerotic acute coronary syndrome, vasospasm, myocarditis
Prevention	No known definitive prevention; control of cardiovascular risk factors and stress
Treatment	Conservative medical management, percutaneous coronary intervention (in select cases), coronary artery bypass grafting (rare)
Medication	Beta blockers, aspirin, clopidogrel; avoid thrombolytics
Prognosis	Generally good with proper management; risk of recurrence exists
Frequency	Rare; more common in women under 50 presenting with acute coronary syndrome
Deaths	Can be fatal if not promptly diagnosed and managed

This is a representative video of coronary angiography. While it does not display SCAD, it highlights the technique used to identify the condition.

This is a representative image of two types of intracoronary imaging, OCT (left) and IVUS (right).

Spontaneous coronary artery dissection (SCAD) is a rare but serious condition that occurs when a tear forms in one of the coronary arteries, which supply blood to the heart. This tear can cause blood to flow between the layers of the artery wall, leading to a blockage that can result in a myocardial infarction (heart attack), arrhythmia, or sudden cardiac death.

Pathophysiology

SCAD involves a separation of the layers of the coronary artery wall, which can create a false lumen. Blood entering this false lumen can compress the true lumen, reducing or obstructing blood flow to the heart muscle. The exact cause of SCAD is not well understood, but it is believed to involve a combination of factors including hormonal changes, connective tissue disorders, and inflammatory conditions.

Epidemiology

SCAD is more common in women, particularly those under the age of 50. It is a significant cause of acute coronary syndrome in young women and is often associated with pregnancy or the postpartum period. However, it can also occur in men and older individuals.

Clinical Presentation

Patients with SCAD typically present with symptoms of acute coronary syndrome, such as chest pain, shortness of breath, and nausea. The condition can mimic other forms of ischemic heart disease, making diagnosis challenging. Electrocardiograms (ECGs) and cardiac biomarkers are often used in the initial assessment.

Diagnosis

The diagnosis of SCAD is usually confirmed through coronary angiography, which can reveal the characteristic appearance of a dissection. Intravascular imaging techniques such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT) may be used to provide more detailed information about the dissection.

Management

The management of SCAD focuses on restoring blood flow to the affected area of the heart and preventing further complications. Treatment options may include conservative management, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG), depending on the severity of the dissection and the patient's clinical condition. Medications such as beta-blockers, antiplatelet agents, and statins may also be prescribed.

Prognosis

The prognosis for patients with SCAD varies. Many patients recover with appropriate treatment, but there is a risk of recurrence. Long-term follow-up and lifestyle modifications are important components of care.

Related pages

• Coronary artery disease
• Myocardial infarction
• Acute coronary syndrome
• Cardiology

External links

Classification	ICD-10: I25.4 DiseasesDB: 3115
External resources

• "Spontaneous Coronary Artery Dissection Postpartum"
• "Spontaneous-Coronary-Artery-Dissection-Case-Series-and-Review"