SPONTANEOUS CORONARY ARTERY DISSECTION

Course overview

SPONTANEOUS CORONARY ARTERY DISSECTION (SCAD) IS A TEAR IN THE WALL OF THE EPICARDIAL CORONARY ARTERY NOT CAUSED BY TRAUMA, CORONARY INTERVENTION, OR ATHEROSCLEROTIC PLAQUE RUPTURE. IT IS CHARACTERIZED BY INTIMAL TEAR, INTRAMURAL HEMATOMA, AND FALSE LUMEN FORMATION, WHICH CAN OBSTRUCT CORONARY BLOOD FLOW AND CAUSE MYOCARDIAL ISCHEMIA. SCAD IS AN EMERGING CAUSE OF ACUTE CORONARY SYNDROME (ACS) IN YOUNG FEMALES WITHOUT ANY KNOWN CARDIOVASCULAR RISK FACTORS. THE ETIOPATHOGENESIS OF THIS ENTITY IS UNCLEAR, AND STUDIES ARE UNDERWAY. THE HYPOTHESES PROPOSED IN THE LITERATURE ARE ABOUT ITS ASSOCIATION WITH FIBROMUSCULAR DYSPLASIA (FMD), EXPOSURE TO FEMALE SEX HORMONES LIKE ESTROGEN AND PROGESTERONE, AND EXTREME PHYSICAL OR EMOTIONAL STRESS. THE MOST COMMON PRESENTATION IS ACS. ECG MAY SHOW ST-SEGMENT CHANGES, AND LAB WORK MAY SHOW AN ELEVATION IN CARDIAC TROPONINS. AN ECHOCARDIOGRAM MAY REVEAL REGIONAL WALL MOTION ABNORMALITIES. DIAGNOSIS IS CONFIRMED PRIMARILY BY CARDIAC CATHETERIZATION AND CORONARY ANGIOGRAM; INTRAVASCULAR IMAGING CAN BE DONE IF A CORONARY ANGIOGRAM IS INCONCLUSIVE. CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY (CCTA) AND MAGNETIC RESONANCE ANGIOGRAPHY CAN BE DONE IN FOLLOW-UP. GENERAL AND INTERVENTIONAL CARDIOLOGISTS, ADVANCED CARDIOVASCULAR IMAGING SPECIALISTS, AND CARDIAC SURGEONS SHOULD BE ON BOARD FOR THE MANAGEMENT.