Spontaneous coronary artery dissection (SCAD): The underdiagnosed cardiac condition that plagues women

Area of Science:

• Cardiology
• Women's Health

Background:

• Coronary heart disease (CHD) is underdiagnosed and undertreated in women, with gender and age bias affecting acute coronary syndrome (ACS) evaluation.
• Spontaneous coronary artery dissection (SCAD) is an infrequent cause of myocardial infarction (MI), particularly in younger to middle-aged women, and is often missed due to low suspicion and unfamiliarity.

Purpose of the Study:

• To highlight the challenges in diagnosing and managing SCAD in women.
• To emphasize the importance of updated diagnostic pathways for myocardial infarction with non-obstructive coronary arteries (MINOCA), including SCAD.
• To underscore the need for increased awareness and research into SCAD.

Main Methods:

• Review of recent European Society of Cardiology (ESC) guidelines for MINOCA assessment.
• Emphasis on the diagnostic utility of cardiac magnetic resonance (CMR) and intracoronary imaging.
• Discussion of associated conditions like fibromuscular dysplasia (FMD) requiring screening.

Main Results:

• SCAD is a significant cause of MI in women, often under-reported.
• New pathways recommend CMR and intracoronary imaging for improved SCAD diagnosis.
• SCAD is linked to connective tissue diseases and arteriopathies like FMD.

Conclusions:

• Early and accurate diagnosis of SCAD is vital to prevent sudden cardiac death and recurrent events.
• There is a lack of consensus on SCAD investigation and treatment, necessitating further research.
• Increased awareness among healthcare providers is essential for better management of SCAD.