Treatment
Database of 11,605 patients
23 had SCAD
Treatment as indicated in the diagram
Vanzatto et al. Eur J Cardiothorac Surg
Summary
All the data available is not enough to come up with a standard way of treatment
“Each case should undergo an individual evaluation in the light of clinical and angiographic presentation”
Meader et al. Int J Cardiol
Approach
Verma et al. Angiology 2004;
Diagnosis And 
Management In
Pregnancy
Diagnosis
Generally the same as the general population
Influenced by fetal safety and normal changes during pregnancy
ST segment changes
Cardiac biomarkers
ST Changes a
picture.
26 patients
Significant ST changes in 42% of patients undergoing elective C-section
38.5% had ST changes post-op
42% developed chest pain requiring analgesia
Majority had normal Troponin
Moran et al. Anaesthesia
Cardiac Biomarkers
CK/CK-MB increase 2 fold with in 30 minutes of delivery
CK-MB peaks at 24 hours post delivery
Troponin remains below the upper limit of normal except in:
Gestational hypertension
Pre-eclampsia
Fleming et al. Br J Obstet Gynaecol
Diagnosis
Essentially similar to the general population
Angiography
CT angiogram
Strict adherence to ALARA principles of radiation protection
Radiation
QuickTime™ and a decompressor
are needed to see this picture.
Should be kept to a minimum
CXR are safe
Cath + intervention <1 rad
Difficult cases 5 – 10 rads
Termination of pregnancy may be considered when doses exceed 10 rads
Colletti PM, Cardiovascular imaging in the pregnant patient in Cardiac Problems in
Pregnancy 3rd edition, 1998
Treatment
Very difficult to give general recommendations
Follow the usual standard of care with a caveat
Maternal-fetal considerations
Involve both the cardiologist and the obstetrician