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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs, particularly the arteries supplying the thighs and calves. In rare cases, it may involve other arteries, including those in the arms.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty...
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Spontaneous coronary artery dissection: dissecting an underdiagnosed problem.

Deborah N Kalkman1, Arja S Vink2, Marcel A M Beijk2

  • 1Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands. d.n.kalkman@amsterdamumc.nl.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|October 28, 2025
PubMed
Summary

Spontaneous coronary artery dissection (SCAD) affects 1-4% of acute coronary syndromes, primarily premenopausal women. Treatment involves antiplatelet therapy and beta-blockers, with a 10-20% recurrence rate despite medical management.

Keywords:
Acute coronary syndromeAntiplatelet therapyFibromuscular dysplasiaHypertensionPeripartumSpontaneous coronary artery dissection

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Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • Spontaneous coronary artery dissection (SCAD) accounts for 1-4% of acute coronary syndromes (ACS).
  • SCAD involves intramural hematoma compressing the coronary artery lumen, causing ischemia or myocardial infarction.
  • It predominantly affects premenopausal women lacking traditional atherosclerosis risk factors.

Purpose of the Study:

  • To summarize the current understanding of SCAD, including diagnosis, management, and outcomes.
  • To highlight the association between SCAD and fibromuscular dysplasia (FMD).
  • To inform evidence-based treatment strategies and future research directions.

Main Methods:

  • Diagnosis relies on invasive coronary angiography, often supplemented by optical coherence tomography or intravascular ultrasound.
  • Risk factor assessment includes screening for fibromuscular dysplasia (FMD) via CT angiography.
  • Treatment recommendations are largely based on expert consensus and observational data.

Main Results:

  • Coronary intervention is typically reserved for complete artery occlusion with persistent ischemia.
  • Long-term medical management includes antiplatelet agents and beta-blockers, often lifelong.
  • Recurrence rates range from 10-20% within 4 years, and nearly two-thirds of patients have associated FMD.

Conclusions:

  • SCAD management requires a multidisciplinary approach, including antiplatelet therapy, beta-blockers, and FMD screening.
  • Patients may benefit from ACE inhibitors or aldosterone receptor blockers if left ventricular systolic dysfunction is present.
  • Ongoing randomized controlled trials aim to establish definitive treatment guidelines for SCAD.