SCAD
Spontaneous Coronary
Artery Dissection: A
Review
WEECREEP 2010
Banff
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Tara Sedlak
Osama Gusbi
Feb 28th, 2010
Outline
Case Study
Epidemiology of SCAD
Etiology
Pregnancy-related SCAD
Clinical presentation
Diagnosis
Treatment/Prognosis
Return to Case
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Case
38 year old G2P1 female, 9 days postpardum from normal vaginal birth
No cardiac risk factors
No medications
No past medical history
No FMHx
Case
Presented to community hospital with sudden-onset RSCP, radiating down both arms, 2 hours in duration
BP 110/70 both arms, HR 40 regular
Normal exam
Initial Troponin I 0.64
ECG
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How should we manage her?
A) Treat her medically for ACS
B) Treat her medically for ACS and send her for cath
C) Send her for an urgent CT scan (triple rule out)
D) Manage her for spasm
Catheterization
Questions We Will
Answer
Was she at risk for SCAD?
How should we have made the diagnosis in her?
How should she be managed?
Should she get pregnant again?
Numbers to Remember
Percentage of AMI in |
9:1 |
|
Pregnancy due to CAD |
||
0.2% |
LAD Involvement |
|
Percentage of SCD |
|
2/3 |
70% |
|
|
|
Presentation in ACS |
|
50% |
Ratio of M:F |
Prevalence of SCAD |
90% |
|
Definition of SCAD
On coronary angiography:
The presence of an intimal flap with false lumen
On pathology:
The separation between intima and media or media and adventitia
To be spontaneous, exclude:
chest trauma, cardiac surgery
coronary angiography
extension of aortic dissection
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