Spontaneous coronary artery dissection differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Spontaneous coronary artery dissection}} | {{Spontaneous coronary artery dissection}} | ||
{{CMG}}; {{AE}}{{AKK}} | {{CMG}}; {{AE}} {{Sara.Zand}} {{AKK}} | ||
{{SK}} SCAD | {{SK}} SCAD | ||
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==Differential Diagnosis== | ==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> | |||
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|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[STEMI]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" | [[STEMI]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] | | style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] with radiation to [[arms]], [[neck]], [[back]], [[jaw]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[ | | style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faint]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]] | | style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[bradycardia]] | | style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[bradycardia]] | ||
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| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]]) | | style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]]) | ||
| style="background: #F5F5F5; padding: 5px;" |↑[[C-reactive protein]], [[BNP]] | | style="background: #F5F5F5; padding: 5px;" |↑[[C-reactive protein]], [[BNP]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |[[Cardiac]] [[magnetic resonance imaging]] ([[CMR]]): [[myocardial edema]], [[microvascular obstruction]], [[intramyocardial hemorrhage]], [[MI]] size | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" |Intravascular imaging during [[PCI]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | 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;" |Occlusive [[coronary]] [[thrombus]] formation superimposed on a ruptured or eroded [[atherosclerotic]] plaque | ||
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|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spontaneous coronary artery dissection]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spontaneous coronary artery dissection]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] | | 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;" |[[Shortness of breath]], [[dizziness]], [[faintness]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]] | | style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]] | ||
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| style="background: #F5F5F5; padding: 5px;" |[[intravascular ultrasound]] ([[IVUS]]), [[optical coherence tomography]] ([[OCT]]) | | 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;" | [[Coronary CT angiography]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | 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;" |[[Intracoronary imaging]] such as [[intravascular ultrasound]] ([[IVUS]]), [[optical coherence tomography]] ([[OCT]]) | ||
| style="background: #F5F5F5; padding: 5px;" |Mimicing [[ECG]] changes of [[STMI]] | | style="background: #F5F5F5; padding: 5px;" |Mimicing [[ECG]] changes of [[STMI]] | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Coronary vasospasm]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Coronary vasospasm]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] | | 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;" |[[Shortness of breath]], [[dizziness]], [[faintness]] | ||
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]] | | style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]] | ||
| Line 98: | Line 101: | ||
| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]]) | | style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]]) | ||
| style="background: #F5F5F5; padding: 5px;" | | | 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;" | | | 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;" | [[ | |||
| style="background: #F5F5F5; padding: 5px;" |[[Coronary angiography]] and [[spasm]] provocation test | | 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]] | | style="background: #F5F5F5; padding: 5px;" |occurring most often from [[midnight]] to early [[morning]], Mimicing [[ECG]] changes of [[STMI]] | ||
|} | |} | ||
Latest revision as of 19:41, 10 April 2021
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Spontaneous Coronary Artery Dissection Microchapters |
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Differentiating Spontaneous coronary artery dissection from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Type 1 Type 2A Type 2B Type 3 |
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]
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)