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Spontaneous Coronary Artery Dissection: An Updated Comprehensive Review
Chibuike C Agwuegbo1, Eman N Ahmed2, Emmanuel Olumuyide3
1Internal Medicine, Southwest Healthcare, Temecula, USA.
Insights
Spontaneous coronary artery dissection (SCAD) is a critical cause of acute coronary syndrome, often missed in diagnosis. This review covers SCAD pathophysiology, diagnosis, and management strategies.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome (ACS).
- SCAD predominantly affects middle-aged women and is linked to various risk factors including hormone use, stress, and COVID-19.
- Accurate and timely diagnosis of SCAD is crucial due to its potentially fatal outcomes.
Purpose of the Study:
- To provide a comprehensive review of spontaneous coronary artery dissection (SCAD).
- To outline the pathophysiology, classification, and diagnostic challenges of SCAD.
- To summarize current evidence and identify gaps in the acute and long-term management of SCAD.
Main Methods:
- Review of existing literature on spontaneous coronary artery dissection (SCAD).
- Analysis of diagnostic modalities, including coronary angiography and intracardiac imaging.
- Evaluation of conservative, medical, and interventional management approaches for SCAD.
Main Results:
- SCAD is classified into four types based on angiographic findings.
- Coronary angiography is the gold standard for SCAD diagnosis, with intracardiac imaging as a supplementary tool.
- Management strategies for SCAD range from conservative to interventional, with cardiac rehabilitation being essential.
Conclusions:
- There is a significant paucity of established guidelines for SCAD management.
- Further research is needed to refine diagnostic criteria and optimize treatment protocols for SCAD.
- A multidisciplinary approach is essential for effective SCAD patient care.
Abstract:
Spontaneous coronary artery dissection (SCAD) is defined as a non-iatrogenic, non-traumatic separation of the coronary artery wall, which has gained considerable recognition as an important cause of acute coronary syndrome. Despite the emerging evidence, it is still frequently missed and requires a high index of suspicion, as failure to accurately identify SCAD promptly could prove fatal. SCAD is most prevalent among middle-aged women, although it can also be found in men and postmenopausal women. Risk factors of SCAD include exogenous hormone use, physical and emotional stressors, pregnancy, and several inflammatory and connective tissue disorders. COVID-19 also contributes to the prevalence of SCAD. SCAD is classified into four main types based on the angiographic findings - type 1, type 2, type 3, and type 4. The gold standard for diagnosis is coronary angiography; however, intracardiac imaging is useful if diagnostic doubts persist. Despite the increasing recognition of this disease, there is a paucity in the guidelines on the management of SCAD. Management may be conservative, medical, or interventional. Cardiac rehabilitation is also necessary in the management of patients with SCAD. In light of the gaps in evidence, the authors aim to provide a comprehensive review of the existing literature, outlining the pathophysiology, classification, and, most importantly, the evidence and pitfalls circulating diagnosis, acute, and long-term management of SCAD.
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