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SCAD is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women. The coronary artery can suddenly develop a tear, causing blood to flow between the layers which forces them apart, potentially causing a blockage of blood flow through the artery and a resulting heart attack. The condition may be related to female hormone levels, as it is often seen in post-partum women, or in women during or very near menstruation, but not always. It is not uncommon for SCAD to occur in people in good physical shape and with no known prior history of heart related illness. It is also not uncommon for SCAD to occur in people in their 20's, 30's, and 40's, as well as older.
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Dr Ramachandra
What does it mean?
Introduction
• Pretty H(1931)-1st reported case• CAG : 0.2% incidence• Mean age :40 yrs• Men:30%,female:70%(peripartum)• LAD(y) in ladies : most commonly
Key pathology
Predisposition
Intimal rupture double lumen
Bleeding into vasa vasorum intramural hematoma abrupt vessel closure
Risk is not clear
remains unclearCAD/ peripartum: most common hypertension CTD:Marfan’s syndrome, EDS, vasculitis:PAN,SLE, eosinophilic arteritis, APS, and IBD
Natural history
• Survival rates of SCAD is 70-90% survival• Outcomes being more favourable should the
acute phase be survived • 1- and 10- year mortality 1.1% and 7.7%• Men tend to have better survival rates • Peri- or postpartum period have an even
better prognosis than not pregnant
Natural history
In a review of 152 cases Kamineni et al. reported that 50% of patients developed recurrent dissection within two months.
Kamineni R., Sadhu A., and Alpert J.S.: Spontaneous coronary artery dissection: report of two cases and a 50-year review of the literature. Cardiology in Review. 2002; 10: pp. 279-284
Natural history
Recurrent dissection within one month of the first event is more common .High chance of developing recurrent dissection if there is a generalised vessel weakness as in pregnant SCAD patients, where more than 40% demonstrated dissections in more than one vessel
Koul A.K., Hollander G., Moskovits N., Frankel R., Herrera L., and Shani J.: Coronary artery dissection during pregnancy and the postpartum period: two case reports and review of literature. Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions. 2001; 52: pp. 88-94
Natural history• Tanis W., Stella P.R., Kirkels J.H., Pijlman A.H., Peters R.H., and de Man F.H.:
Spontaneous coronary artery dissection: current insights and therapy. Netherlands Heart Journal: Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. 2008; 16: pp. 344-349
• Hering D., Piper C., Hohmann C., Schultheiss H.P., and Horstkotte D.: [Prospective study of the incidence, pathogenesis and therapy of spontaneous, by coronary angiography diagnosed coronary artery dissection]. Zeitschrift fur Kardiologie. 1998; 87: pp. 961-970
• Kamineni R., Sadhu A., and Alpert J.S.: Spontaneous coronary artery dissection: report of two cases and a 50-year review of the literature. Cardiology in Review. 2002; 10: pp. 279-284
• Maeder M., Ammann P., Angehrn W., and Rickli H.: Idiopathic spontaneous coronary artery dissection: incidence, diagnosis and treatment. International Journal of Cardiology. 2005; 101: pp. 363-369
Must be individualizedRx like ACS(+UFH)GP IIB-IIIA/TLT is a either edged sword-choose it carefullyAngioplasty/surgery to the needClose F/U must
Follow me up
• Progression of the dissection and formation of pseudoaneurysms
• Any symptoms of recurrent ischemia• Stress testing with nuclear perfusion imaging
is preferred over coronary angiography as a means of surveillance
Conclusion
• Any young woman• Nil risk factors for coronary artery disease and
acute myocardial infarction• Propensity for extension of dissection with or
without mechanical revascularization• Spontaneous healing• Medical a is rational • Therapy must be individualized
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