Spontaneous coronary artery dissection medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
There are no specific guidelines regarding the optimal management of spontaneous coronary artery dissection. Based on the clinical and angiographic scenario, treatment options include conservative medical regimens similar to that for [[acute coronary syndrome]], [[percutaneous coronary intervention]], and/or [[coronary artery bypass surgery]]. In the majority of cases, SCAD may be managed successfully with medical treatment alone in the absence of ongoing [[myocardial ischemia]] or [[hemodynamic instability]].<ref name="pmid25294399">{{cite journal| author=Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D et al.| title=Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 5 | pages= 645-55 | pmid=25294399 | doi=10.1161/CIRCINTERVENTIONS.114.001760 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25294399 }} </ref><ref name="pmid22800851">{{cite journal| author=Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ et al.| title=Clinical features, management, and prognosis of spontaneous coronary artery dissection. | journal=Circulation | year= 2012 | volume= 126 | issue= 5 | pages= 579-88 | pmid=22800851 | doi=10.1161/CIRCULATIONAHA.112.105718 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22800851 }} </ref> Initial conservative management typically includes antithrombotic therapy with [[heparin]], [[aspirin]], [[clopidogrel]] and [[glycoprotein IIb/IIIa inhibitors]], and antiischemic therapy with [[beta blockers]] and [[nitrate]]s. However, the use of antithrombotic therapy may increase the risk of bleeding in the false lumen causing an expansion of the intramural hematoma, resulting in a decreased flow through the true lumen.<ref name="Vrints-2010">{{Cite journal | last1 = Vrints | first1 = CJ. | title = Spontaneous coronary artery dissection. | journal = Heart | volume = 96 | issue = 10 | pages = 801-8 | month = May | year = 2010 | doi = 10.1136/hrt.2008.162073 | PMID = 20448134 }}</ref> [[Fibrinolytic]]s should be avoided. [[Calcium channel blocker]]s may offer relief in [[coronary artery spasm]]. | |||
==References== | ==References== | ||
Revision as of 16:57, 21 November 2017
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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: Nate Michalak, B.A.
Synonyms and keywords: SCAD
Overview
Medical Therapy
There are no specific guidelines regarding the optimal management of spontaneous coronary artery dissection. Based on the clinical and angiographic scenario, treatment options include conservative medical regimens similar to that for acute coronary syndrome, percutaneous coronary intervention, and/or coronary artery bypass surgery. In the majority of cases, SCAD may be managed successfully with medical treatment alone in the absence of ongoing myocardial ischemia or hemodynamic instability.[1][2] Initial conservative management typically includes antithrombotic therapy with heparin, aspirin, clopidogrel and glycoprotein IIb/IIIa inhibitors, and antiischemic therapy with beta blockers and nitrates. However, the use of antithrombotic therapy may increase the risk of bleeding in the false lumen causing an expansion of the intramural hematoma, resulting in a decreased flow through the true lumen.[3] Fibrinolytics should be avoided. Calcium channel blockers may offer relief in coronary artery spasm.
References
- ↑ Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D; et al. (2014). "Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes". Circ Cardiovasc Interv. 7 (5): 645–55. doi:10.1161/CIRCINTERVENTIONS.114.001760. PMID 25294399.
- ↑ Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ; et al. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851.
- ↑ Vrints, CJ. (2010). "Spontaneous coronary artery dissection". Heart. 96 (10): 801–8. doi:10.1136/hrt.2008.162073. PMID 20448134. Unknown parameter
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