Spontaneous coronary artery dissection differential diagnosis: Difference between revisions

	Spontaneous Coronary Artery Dissection Microchapters
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Overview
Historical Perspective
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Differentiating Spontaneous coronary artery dissection from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Approach
History and Symptoms
Physical Examination
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Type 1 Case 1; Case 2; Case 3; Case 4; Case 5; Case 6; Case 7; Type 2A Case 1; Case 2; Case 3; Case 4; Case 5; Case 6; Type 2B Case 1; Case 2; Case 3; Case 4; Type 3 Case 1; Case 2; Case 3; Case 4; Case 5; Case 6;

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Latest revision as of 19:41, 10 April 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Arzu Kalayci, M.D. [3]

Synonyms and keywords: SCAD

Overview

Spontaneous coronary artery dissection should be differentiated from other causes of acute coronary syndrome. Features suggestive of spontaneous coronary artery dissection include myocardial infarction in young women (age ≤50), absence of traditional cardiovascular risk factors, little or no evidence of coronary atherosclerosis, peripartum state, history of fibromuscular dysplasia, and history of connective tissue disorder or systemic inflammatory disorder.

Differential Diagnosis

Albeit an infrequent condition, spontaneous coronary artery dissection (SCAD) should be included in the differential diagnosis of acute coronary syndrome, particularly among young women with risk factors such as vasculopathy, pregnancy, connective tissue disorder, systemic inflammation, strenuous exercise, emotional stress, or recreational drug use. While demographic and angiographic characteristics may be useful in differentiating SCAD from other causes of myocardial ischemia, intracoronary imaging such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) may be required for establishing a definitive diagnosis.

Differentiating spontaneous coronary artery dissection from other diseases

^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]

	Symptoms			Physical examination			Lab Findings			Imaging			Histopathology
Diseases	Clinical manifestations						Para-clinical findings							Gold standard	Additional findings
	Symptoms			Physical examination			Para-clinical findings
	Symptom 1	Symptom 2	Symptom 3	Physical exam 1	Physical exam 2	Physical exam 3	Lab 1	Lab 2	Lab 3	Imaging 1	Imaging 2	Imaging 3	Histopathology
STEMI	Chest discomfort with radiation to arms, neck, back, jaw	Shortness of breath, dizziness, faint	Nausea, vomiting, sweating	Tachycardia, bradycardia	Hypertension, hypotension, syncope	S4 heart sound, rale, holosystolic murmur in apex	↑Troponin I, T	↑Creatin kinase MB (CKMB)	↑C-reactive protein, BNP	Cardiac magnetic resonance imaging (CMR): myocardial edema, microvascular obstruction, intramyocardial hemorrhage, MI size	Intravascular imaging during PCI		Occlusive coronary thrombus formation superimposed on a ruptured or eroded atherosclerotic plaque	Coronary angiography
Spontaneous coronary artery dissection	Chest discomfort with radiation to arms, neck, back, jaw	Shortness of breath, dizziness, faintness	Nausea, vomiting, sweating	Tachycardia, bradycardia	Hypertension, hypotension, syncope	rale, holosystolic murmur in apex	↑Troponin I, T	↑Creatin kinase MB (CKMB)		Coronary angiography	intravascular ultrasound (IVUS), optical coherence tomography (OCT)	Coronary CT angiography	Intimal tear, medial dissection, hemorrhage formation, false lumen formation.Hematoma formation in media, separation of two arterial layers, formation of false lumen, dissection of the true lumen	Intracoronary imaging such as intravascular ultrasound (IVUS), optical coherence tomography (OCT)	Mimicing ECG changes of STMI
Coronary vasospasm	Chest discomfort with radiation to arms, neck, back, jaw	Shortness of breath, dizziness, faintness	Nausea, vomiting, sweating	Tachycardia, bradycardia	Hypertension, hypotension, syncope	Rale, holosystolic murmur in apex	↑Troponin I, T	↑Creatin kinase MB (CKMB)		IVUS findings: negative remodeling, diffuse intima, thick media, and wrinkles in the internal elastic membrane even in the absence of a significant coronary stenosis			Morphologic changes in the artery at the site of the spasm, endothelium damaged, Platelets aggregation at this site releasing vasoactive substances, thrombin formation	Coronary angiography and spasm provocation test	occurring most often from midnight to early morning, Mimicing ECG changes of STMI

References

↑ Paulo, Manuel; Sandoval, Jorge; Lennie, Vera; Dutary, Jaime; Medina, Miguel; Gonzalo, Nieves; Jimenez-Quevedo, Pilar; Escaned, Javier; Bañuelos, Camino; Hernandez, Rosana; Macaya, Carlos; Alfonso, Fernando (2013). "Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection". JACC: Cardiovascular Imaging. 6 (7): 830–832. doi:10.1016/j.jcmg.2013.02.010. ISSN 1936-878X.
↑ Adlam, David; Alfonso, Fernando; Maas, Angela; Vrints, Christiaan; al-Hussaini, Abtehale; Bueno, Hector; Capranzano, Piera; Gevaert, Sofie; Hoole, Stephen P; Johnson, Tom; Lettieri, Corrado; Maeder, Micha T; Motreff, Pascal; Ong, Peter; Persu, Alexandre; Rickli, Hans; Schiele, Francois; Sheppard, Mary N; Swahn, Eva (2018). "European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection". European Heart Journal. 39 (36): 3353–3368. doi:10.1093/eurheartj/ehy080. ISSN 0195-668X.
↑ . doi:10.1136/2Fhrt.53.4.363. Missing or empty |title= (help)
↑ Davies, Michael J. (1996). "The contribution of thrombosis to the clinical expression of coronary atherosclerosis". Thrombosis Research. 82 (1): 1–32. doi:10.1016/0049-3848(96)00035-7. ISSN 0049-3848.
↑ YASUE, Hirofumi; MIZUNO, Yuji; HARADA, Eisaku (2019). "Coronary artery spasm — Clinical features, pathogenesis and treatment —". Proceedings of the Japan Academy, Series B. 95 (2): 53–66. doi:10.2183/pjab.95.005. ISSN 0386-2208.
↑ Shepherd, John T.; Vanhoutte, Paul M. (1985). "Spasm of the Coronary Arteries: Causes and Consequences (the Scientist's Viewpoint)". Mayo Clinic Proceedings. 60 (1): 33–46. doi:10.1016/S0025-6196(12)65280-X. ISSN 0025-6196.
↑ Koyama, Jun; Yamagishi, Masakazu; Tamai, Jun; Kawano, Shigeo; Daikoku, Satoshi; Miyatake, Kunio (1995). "Comparison of vessel wall morphologic appearance a sites of focal and diffuse coronary vasospasm by intravascular ultrasound". American Heart Journal. 130 (3): 440–445. doi:10.1016/0002-8703(95)90349-6. ISSN 0002-8703.
↑ Miyao, Yuji; Kugiyama, Kiyotaka; Kawano, Hiroaki; Motoyama, Takeshi; Ogawa, Hisao; Yoshimura, Michihiro; Sakamoto, Tomohiro; Yasue, Hirofumi (2000). "Diffuse intimal thickening of coronary arteries in patients with coronary spastic angina". Journal of the American College of Cardiology. 36 (2): 432–437. doi:10.1016/S0735-1097(00)00729-4. ISSN 0735-1097.
↑ Tweet, Marysia S.; Gulati, Rajiv; Williamson, Eric E.; Vrtiska, Terri J.; Hayes, Sharonne N. (2016). "Multimodality Imaging for Spontaneous Coronary Artery Dissection in Women". JACC: Cardiovascular Imaging. 9 (4): 436–450. doi:10.1016/j.jcmg.2016.01.009. ISSN 1936-878X.
↑ Bulluck, Heerajnarain; Dharmakumar, Rohan; Arai, Andrew E.; Berry, Colin; Hausenloy, Derek J. (2018). "Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction". Circulation. 137 (18): 1949–1964. doi:10.1161/CIRCULATIONAHA.117.030693. ISSN 0009-7322.
↑ . doi:10.1016/j.carreu.2020.09.032. Missing or empty |title= (help)

[PauloSandoval2013-1] Paulo, Manuel; Sandoval, Jorge; Lennie, Vera; Dutary, Jaime; Medina, Miguel; Gonzalo, Nieves; Jimenez-Quevedo, Pilar; Escaned, Javier; Bañuelos, Camino; Hernandez, Rosana; Macaya, Carlos; Alfonso, Fernando (2013). "Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection". JACC: Cardiovascular Imaging. 6 (7): 830–832. doi:10.1016/j.jcmg.2013.02.010. ISSN 1936-878X.

[AdlamAlfonso2018-2] Adlam, David; Alfonso, Fernando; Maas, Angela; Vrints, Christiaan; al-Hussaini, Abtehale; Bueno, Hector; Capranzano, Piera; Gevaert, Sofie; Hoole, Stephen P; Johnson, Tom; Lettieri, Corrado; Maeder, Micha T; Motreff, Pascal; Ong, Peter; Persu, Alexandre; Rickli, Hans; Schiele, Francois; Sheppard, Mary N; Swahn, Eva (2018). "European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection". European Heart Journal. 39 (36): 3353–3368. doi:10.1093/eurheartj/ehy080. ISSN 0195-668X.

[3] . doi:10.1136/2Fhrt.53.4.363. Missing or empty |title= (help)

[Davies1996-4] Davies, Michael J. (1996). "The contribution of thrombosis to the clinical expression of coronary atherosclerosis". Thrombosis Research. 82 (1): 1–32. doi:10.1016/0049-3848(96)00035-7. ISSN 0049-3848.

[YASUEMIZUNO2019-5] YASUE, Hirofumi; MIZUNO, Yuji; HARADA, Eisaku (2019). "Coronary artery spasm — Clinical features, pathogenesis and treatment —". Proceedings of the Japan Academy, Series B. 95 (2): 53–66. doi:10.2183/pjab.95.005. ISSN 0386-2208.

[ShepherdVanhoutte1985-6] Shepherd, John T.; Vanhoutte, Paul M. (1985). "Spasm of the Coronary Arteries: Causes and Consequences (the Scientist's Viewpoint)". Mayo Clinic Proceedings. 60 (1): 33–46. doi:10.1016/S0025-6196(12)65280-X. ISSN 0025-6196.

[KoyamaYamagishi1995-7] Koyama, Jun; Yamagishi, Masakazu; Tamai, Jun; Kawano, Shigeo; Daikoku, Satoshi; Miyatake, Kunio (1995). "Comparison of vessel wall morphologic appearance a sites of focal and diffuse coronary vasospasm by intravascular ultrasound". American Heart Journal. 130 (3): 440–445. doi:10.1016/0002-8703(95)90349-6. ISSN 0002-8703.

[MiyaoKugiyama2000-8] Miyao, Yuji; Kugiyama, Kiyotaka; Kawano, Hiroaki; Motoyama, Takeshi; Ogawa, Hisao; Yoshimura, Michihiro; Sakamoto, Tomohiro; Yasue, Hirofumi (2000). "Diffuse intimal thickening of coronary arteries in patients with coronary spastic angina". Journal of the American College of Cardiology. 36 (2): 432–437. doi:10.1016/S0735-1097(00)00729-4. ISSN 0735-1097.

[TweetGulati2016-9] Tweet, Marysia S.; Gulati, Rajiv; Williamson, Eric E.; Vrtiska, Terri J.; Hayes, Sharonne N. (2016). "Multimodality Imaging for Spontaneous Coronary Artery Dissection in Women". JACC: Cardiovascular Imaging. 9 (4): 436–450. doi:10.1016/j.jcmg.2016.01.009. ISSN 1936-878X.

[BulluckDharmakumar2018-10] Bulluck, Heerajnarain; Dharmakumar, Rohan; Arai, Andrew E.; Berry, Colin; Hausenloy, Derek J. (2018). "Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction". Circulation. 137 (18): 1949–1964. doi:10.1161/CIRCULATIONAHA.117.030693. ISSN 0009-7322.

[11] . doi:10.1016/j.carreu.2020.09.032. Missing or empty |title= (help)

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 __NOTOC__
 {{Spontaneous coronary artery dissection}}
-{{CMG}}; {{AE}}{{AKK}}
+{{CMG}}; {{AE}} {{Sara.Zand}} {{AKK}}
 {{SK}} SCAD
 ==Overview==
+[[Spontaneous coronary artery dissection]] should be differentiated from other causes of [[acute coronary syndrome]]. Features suggestive of [[spontaneous coronary artery dissection]] include [[myocardial infarction]] in young [[women]] (age ≤50), absence of traditional [[Cardiovascular disease#Risk factors|cardiovascular risk factors]], little or no evidence of [[coronary atherosclerosis]], [[Peripartum|peripartum state]], history of [[fibromuscular dysplasia]], and history of [[connective tissue disorder]] or [[systemic inflammation|systemic inflammatory disorder]].
+==Differential Diagnosis==
+Albeit an infrequent condition, [[spontaneous coronary artery dissection]] ([[SCAD]]) should be included in the differential diagnosis of [[acute coronary syndrome|acute coronary syndrome]], particularly among young [[women]] with [[risk factors]] such as [[vasculopathy]], [[pregnancy]], [[connective tissue disorder]], [[systemic inflammation]], [[exercise|strenuous exercise]], [[emotional stress]], or [[recreational drug use]].  While demographic and angiographic characteristics may be useful in differentiating [[SCAD]] from other causes of [[myocardial ischemia]], intracoronary imaging such as [[intravascular ultrasound|intravascular ultrasound]] ([[IVUS]]) and [[optical coherence tomography|optical coherence tomography]] ([[OCT]]) may be required for establishing a definitive diagnosis.
+===Differentiating [[spontaneous coronary artery dissection]] from other diseases ===
+<ref name="PauloSandoval2013">{{cite journal|last1=Paulo|first1=Manuel|last2=Sandoval|first2=Jorge|last3=Lennie|first3=Vera|last4=Dutary|first4=Jaime|last5=Medina|first5=Miguel|last6=Gonzalo|first6=Nieves|last7=Jimenez-Quevedo|first7=Pilar|last8=Escaned|first8=Javier|last9=Bañuelos|first9=Camino|last10=Hernandez|first10=Rosana|last11=Macaya|first11=Carlos|last12=Alfonso|first12=Fernando|title=Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection|journal=JACC: Cardiovascular Imaging|volume=6|issue=7|year=2013|pages=830–832|issn=1936878X|doi=10.1016/j.jcmg.2013.02.010}}</ref><ref name="AdlamAlfonso2018">{{cite journal|last1=Adlam|first1=David|last2=Alfonso|first2=Fernando|last3=Maas|first3=Angela|last4=Vrints|first4=Christiaan|last5=al-Hussaini|first5=Abtehale|last6=Bueno|first6=Hector|last7=Capranzano|first7=Piera|last8=Gevaert|first8=Sofie|last9=Hoole|first9=Stephen P|last10=Johnson|first10=Tom|last11=Lettieri|first11=Corrado|last12=Maeder|first12=Micha T|last13=Motreff|first13=Pascal|last14=Ong|first14=Peter|last15=Persu|first15=Alexandre|last16=Rickli|first16=Hans|last17=Schiele|first17=Francois|last18=Sheppard|first18=Mary N|last19=Swahn|first19=Eva|title=European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection|journal=European Heart Journal|volume=39|issue=36|year=2018|pages=3353–3368|issn=0195-668X|doi=10.1093/eurheartj/ehy080}}</ref><ref>{{cite journal|doi=10.1136/2Fhrt.53.4.363}}</ref><ref name="Davies1996">{{cite journal|last1=Davies|first1=Michael J.|title=The contribution of thrombosis to the clinical expression of coronary atherosclerosis|journal=Thrombosis Research|volume=82|issue=1|year=1996|pages=1–32|issn=00493848|doi=10.1016/0049-3848(96)00035-7}}</ref><ref name="YASUEMIZUNO2019">{{cite journal|last1=YASUE|first1=Hirofumi|last2=MIZUNO|first2=Yuji|last3=HARADA|first3=Eisaku|title=Coronary artery spasm — Clinical features, pathogenesis and treatment —|journal=Proceedings of the Japan Academy, Series B|volume=95|issue=2|year=2019|pages=53–66|issn=0386-2208|doi=10.2183/pjab.95.005}}</ref><ref name="ShepherdVanhoutte1985">{{cite journal|last1=Shepherd|first1=John T.|last2=Vanhoutte|first2=Paul M.|title=Spasm of the Coronary Arteries: Causes and Consequences (the Scientist's Viewpoint)|journal=Mayo Clinic Proceedings|volume=60|issue=1|year=1985|pages=33–46|issn=00256196|doi=10.1016/S0025-6196(12)65280-X}}</ref><ref name="KoyamaYamagishi1995">{{cite journal|last1=Koyama|first1=Jun|last2=Yamagishi|first2=Masakazu|last3=Tamai|first3=Jun|last4=Kawano|first4=Shigeo|last5=Daikoku|first5=Satoshi|last6=Miyatake|first6=Kunio|title=Comparison of vessel wall morphologic appearance a sites of focal and diffuse coronary vasospasm by intravascular ultrasound|journal=American Heart Journal|volume=130|issue=3|year=1995|pages=440–445|issn=00028703|doi=10.1016/0002-8703(95)90349-6}}</ref><ref name="MiyaoKugiyama2000">{{cite journal|last1=Miyao|first1=Yuji|last2=Kugiyama|first2=Kiyotaka|last3=Kawano|first3=Hiroaki|last4=Motoyama|first4=Takeshi|last5=Ogawa|first5=Hisao|last6=Yoshimura|first6=Michihiro|last7=Sakamoto|first7=Tomohiro|last8=Yasue|first8=Hirofumi|title=Diffuse intimal thickening of coronary arteries in patients with coronary spastic angina|journal=Journal of the American College of Cardiology|volume=36|issue=2|year=2000|pages=432–437|issn=07351097|doi=10.1016/S0735-1097(00)00729-4}}</ref><ref name="TweetGulati2016">{{cite journal|last1=Tweet|first1=Marysia S.|last2=Gulati|first2=Rajiv|last3=Williamson|first3=Eric E.|last4=Vrtiska|first4=Terri J.|last5=Hayes|first5=Sharonne N.|title=Multimodality Imaging for Spontaneous Coronary Artery Dissection in Women|journal=JACC: Cardiovascular Imaging|volume=9|issue=4|year=2016|pages=436–450|issn=1936878X|doi=10.1016/j.jcmg.2016.01.009}}</ref><ref name="BulluckDharmakumar2018">{{cite journal|last1=Bulluck|first1=Heerajnarain|last2=Dharmakumar|first2=Rohan|last3=Arai|first3=Andrew E.|last4=Berry|first4=Colin|last5=Hausenloy|first5=Derek J.|title=Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction|journal=Circulation|volume=137|issue=18|year=2018|pages=1949–1964|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.030693}}</ref><ref>{{cite journal|doi=10.1016/j.carreu.2020.09.032}}</ref>
-==Differential Diagnosis==
-Albeit an infrequent condition, spontaneous coronary artery dissection (SCAD) should be included in the differential diagnosis of [[acute coronary syndrome|acute coronary syndrome (ACS)]]. Demographic and angiographic characteristics may be useful in differentiating SCAD from other causes of ACS.
-Demographic characteristics that raise the index of suspicion for SCAD include:<ref name="pmid24227590">{{cite journal| author=Saw J| title=Coronary angiogram classification of spontaneous coronary artery dissection. | journal=Catheter Cardiovasc Interv | year= 2014 | volume= 84 | issue= 7 | pages= 1115-22 | pmid=24227590 | doi=10.1002/ccd.25293 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24227590  }}</ref>
+{|
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+! rowspan="4"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases
+| colspan="6" rowspan="1"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''
+! colspan="7" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Para-clinical findings
+| colspan="1" rowspan="4"  style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''
+! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings
+|-
+| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''
+! colspan="3" rowspan="2"  style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination
+|-
+! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab Findings
+! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging
+! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Histopathology
+|-
+! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 1
+! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 2
+! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 3
+! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 1
+! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 2
+! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 3
+! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 1
+! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 2
+! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 3
+! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 1
+! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 2
+! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 3
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[STEMI]]
+| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] with radiation to [[arms]], [[neck]], [[back]], [[jaw]]
+| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faint]]
+| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
+| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[bradycardia]]
+| style="background: #F5F5F5; padding: 5px;" |[[Hypertension]], [[hypotension]], [[syncope]]
+| style="background: #F5F5F5; padding: 5px;" |[[S4]] [[heart sound]], [[rale]], [[holosystolic murmur]] in apex
+| style="background: #F5F5F5; padding: 5px;" |↑[[Troponin]] I, T
+| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
+| style="background: #F5F5F5; padding: 5px;" |↑[[C-reactive protein]], [[BNP]]
+| style="background: #F5F5F5; padding: 5px;" |[[Cardiac]] [[magnetic resonance imaging]] ([[CMR]]): [[myocardial edema]], [[microvascular obstruction]], [[intramyocardial hemorrhage]], [[MI]] size
+| style="background: #F5F5F5; padding: 5px;" |Intravascular imaging during [[PCI]]
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Occlusive [[coronary]] [[thrombus]] formation superimposed on a ruptured or eroded [[atherosclerotic]] plaque
+| style="background: #F5F5F5; padding: 5px;" |[[Coronary angiography]]
+| style="background: #F5F5F5; padding: 5px;" |
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spontaneous coronary artery dissection]]
+| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] with radiation to [[arms]], [[neck]], [[back]], [[jaw]]
+| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faintness]]
+| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
+| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[bradycardia]]
+| style="background: #F5F5F5; padding: 5px;" |[[Hypertension]], [[hypotension]], [[syncope]]
+| style="background: #F5F5F5; padding: 5px;" | [[rale]], [[holosystolic murmur]] in apex
+| style="background: #F5F5F5; padding: 5px;" |↑[[Troponin]] I, T
+| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |[[Coronary angiography]]
+| style="background: #F5F5F5; padding: 5px;" |[[intravascular ultrasound]] ([[IVUS]]), [[optical coherence tomography]] ([[OCT]])
+| style="background: #F5F5F5; padding: 5px;" | [[Coronary CT angiography]]
+| style="background: #F5F5F5; padding: 5px;" |'''[[Intimal]] [[tear]]''', [[medial dissection]], [[hemorrhage formation]], [[false lumen]] formation.'''[[Hematoma ]]''' formation in [[media]], separation of two arterial layers, formation of false [[lumen]], dissection of the true [[lumen]]
+| style="background: #F5F5F5; padding: 5px;" |[[Intracoronary imaging]] such as [[intravascular ultrasound]] ([[IVUS]]), [[optical coherence tomography]] ([[OCT]])
+| style="background: #F5F5F5; padding: 5px;" |Mimicing [[ECG]] changes of  [[STMI]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Coronary vasospasm]]
+| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] with radiation to [[arms]], [[neck]], [[back]], [[jaw]]
+| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faintness]]
+| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
+| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[bradycardia]]
+| style="background: #F5F5F5; padding: 5px;" |[[Hypertension]], [[hypotension]], [[syncope]]
+| style="background: #F5F5F5; padding: 5px;" |[[Rale]], [[holosystolic murmur]] in apex
+| style="background: #F5F5F5; padding: 5px;" |↑[[Troponin]] I, T
+| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | [[IVUS]] findings: negative [[remodeling]], diffuse [[intima]], thick media, and wrinkles in the internal elastic membrane even in the absence of a significant [[coronary stenosis]]
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | [[Morphologic]] changes in the [[artery]] at the site of the [[spasm]], [[endothelium]] damaged, [[Platelets]] aggregation at this site  releasing [[vasoactive]] substances, [[thrombin]] formation
+| style="background: #F5F5F5; padding: 5px;" |[[Coronary angiography]] and [[spasm]] provocation test
+| style="background: #F5F5F5; padding: 5px;" |occurring most often from [[midnight]] to early [[morning]], Mimicing [[ECG]] changes of  [[STMI]]
-* [[Myocardial infarction]] in young women (age ≤50)
+|}
-* Absence of traditional [[Cardiovascular disease#Risk factors|cardiovascular risk factors]]
-* Little or no evidence of [[coronary atherosclerosis]]
-* [[Peripartum|Peripartum state]]
-* History of [[fibromuscular dysplasia]]
-* History of [[connective tissue disorder]] or [[systemic inflammation|systemic inflammatory disorder]]:
-:* [[Marfan's syndrome]]
-:* [[Ehlers-Danlos syndrome|Type 4 Ehlers-Danlos syndrome]]
-:* [[Loeys-Dietz syndrome]]
-:* [[Cystic medial necrosis]]
-:* [[Systemic lupus erythematosus]]
-:* [[Crohn's disease]]
-:* [[Ulcerative colitis]]
-:* [[Polyarteritis nodosa]]
-:* [[Sarcoidosis]]
-:* [[Churg-Strauss syndrome]]
-:* [[Wegener's granulomatosis]]
-:* [[Rheumatoid arthritis]]
-:* [[Giant cell arteritis]]
 ==References==
-{{Reflist|2}}
+{{Reflist}}
 [[Category:Cardiology]]
 [[Category:Angiographic Definitions]]
 [[Category:Disease]]