Chayakrit Krittanawong1,2, Jacqueline Saw3, Jeffrey W Olin4. 1. Section of Cardiology, Baylor School of Medicine and the Michael E. DeBakey VA Medical Center, 1 Baylor Plaza, Houston, TX, 77030, USA. Chayakrit.Krittanawong@bcm.edu. 2. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA. Chayakrit.Krittanawong@bcm.edu. 3. Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada. 4. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA.
Abstract
PURPOSE OF REVIEW: To review the epidemiology, pathogenesis, diagnosis using emerging imaging modalities, management strategy, and prevention of recurrent spontaneous coronary artery dissection (SCAD) and provide a more extensive review of the current data. RECENT FINDINGS: SCAD generally affects women without conventional cardiovascular risk factors. Diagnosis and management of SCAD are challenging due to heterogeneity, undefined mechanisms, differing phenotypes, and a lack of strong clinical evidence. After reviewing the current evidence to date, we recommend conservative management, including cardiac rehabilitation for SCAD with low-risk features, while coronary revascularization should be considered in SCAD with high-risk features. Non-invasive imaging (e.g., coronary computed tomography angiography, cardiac magnetic resonance, myocardial perfusion imaging) should be considered in diagnosing specific SCAD phenotypes. The standard guideline-based medical therapy for acute coronary syndrome, in the absence of contraindications, should be considered along with appropriate SCAD phenotypes. Discharge counseling and follow-up using emerging imaging modalities should be based on individuals' profiles and approached on a case by case basis.
PURPOSE OF REVIEW: To review the epidemiology, pathogenesis, diagnosis using emerging imaging modalities, management strategy, and prevention of recurrent spontaneous coronary artery dissection (SCAD) and provide a more extensive review of the current data. RECENT FINDINGS: SCAD generally affects women without conventional cardiovascular risk factors. Diagnosis and management of SCAD are challenging due to heterogeneity, undefined mechanisms, differing phenotypes, and a lack of strong clinical evidence. After reviewing the current evidence to date, we recommend conservative management, including cardiac rehabilitation for SCAD with low-risk features, while coronary revascularization should be considered in SCAD with high-risk features. Non-invasive imaging (e.g., coronary computed tomography angiography, cardiac magnetic resonance, myocardial perfusion imaging) should be considered in diagnosing specific SCAD phenotypes. The standard guideline-based medical therapy for acute coronary syndrome, in the absence of contraindications, should be considered along with appropriate SCAD phenotypes. Discharge counseling and follow-up using emerging imaging modalities should be based on individuals' profiles and approached on a case by case basis.
Authors: Serigne Cheikh Tidiane Ndao; Amer Zabalawi; Mame Madjiguène Ka; Khadidiatou Dia; Waly N Mboup; Djibril M Ba; Laurent L P Payot; Régis T Delaunay; Pape D Fall; Mouhamed Cherif Mboup Journal: Am J Case Rep Date: 2021-12-25