Cardiac CT
Images can be obtained quickly and accurately
May identify SCAD in young patients with no atherosclerotic risk factors
Allows judicious use of thrombolytics
Dwyer et al. Heart, Lung and Circulation
CT Imaging
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Treatment
Standard therapy has not been established
Options include:
Medical therapy
Interventional procedures
CABG
Transplant
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De Macedo et al. J Invasive Cardiol
Treatment
Therapy depends on several factors:
Site of dissection
One or multivessel involvement
Coronary blood flow
Hemodynamic state
Da Gama et al. J Invasive Cardiol
Medical Treatment
Indications:
Single vessel disease
LM not involved
No signs of ongoing ischemia
Hemodynamically stable
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Meader et al. Int J Cardiol
Medical Treatment
ASA (? duration)
Clopidogrel (? duration)
Heparin (UFH or LMWH)
GP IIb/IIIa inhibitors (one case report)
Beta blockers (no good data-generally used)
Nitrates/CCB are used in case of spasm
Meader et al. Int J Cardiol
Thrombolysis
Has been used to good effect in several cases
Lyses clot in the false lumen
Relief of compression in the true lumen
Has been associated with extension of the dissection
Fatal outcomes
Generally not recommended
Behnam et al. Clin Cardiol
Interventional
Procedures
The treatment of choice in:
Single vessel involvement
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Persistent impairment of blood flow
Ongoing signs of ischemia
Detecting the true lumen can be challenging
Dilatation without stenting should be avoided
Meader et al. Int J Cardiol 2005;101:363-369
Vale et al. Cathet Cardiovasc Diagn
1998;45:280-6
CABG
Indications include:
LM dissection
Multivessel disease
Failure of interventional procedures
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In some cases, LM dissection and multivessel involvement maybe treated with stenting
Dhawan et al. Angiology 2002;53:89-93 Vale et al. Cathet Cardiovasc Diagn 1998;45:280-6
Tongi et al. Am J Med 1999;107:407-8
Cardiac Transplant
Indications include:
Extensive myocardial injury
Patients who develop severe heart failure
Curiel et al. Am J Obstet Gynecol