Spontaneous coronary artery dissection differential diagnosis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
While Type 1 SCAD has a pathognomonic appearance on angiography, Type 2 may be and Type 3 typically is indistinguishable from [[atherosclerosis]]. Risk factors and patient history may help determine diagnosis. Intracoronary imaging provides the most objective tool in differentiating between SCAD and [[atheroma]].<ref name="pmid25774346">{{cite journal| author=Yip A, Saw J| title=Spontaneous coronary artery dissection-A review. | journal=Cardiovasc Diagn Ther | year= 2015 | volume= 5 | issue= 1 | pages= 37-48 | pmid=25774346 | doi=10.3978/j.issn.2223-3652.2015.01.08 | pmc=4329168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25774346 }} </ref> | While Type 1 SCAD has a pathognomonic appearance on angiography, Type 2 may be and Type 3 typically is indistinguishable from [[atherosclerosis]]. Risk factors and patient history may help determine diagnosis. Intracoronary imaging provides the most objective tool in differentiating between SCAD and [[atheroma]].<ref name="pmid25774346">{{cite journal| author=Yip A, Saw J| title=Spontaneous coronary artery dissection-A review. | journal=Cardiovasc Diagn Ther | year= 2015 | volume= 5 | issue= 1 | pages= 37-48 | pmid=25774346 | doi=10.3978/j.issn.2223-3652.2015.01.08 | pmc=4329168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25774346 }} </ref> | ||
{| class="wikitable" style="width: 80%; text-align: justify;" | |||
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Clinical-Angiographic Score System for SCAD Faster Diagnosis}} | |||
|- | |||
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Clinical Characteristics}} | |||
|- | |||
| Connective tissue disorder (Marfan syndrome, Ehler-Danlos syndrome, cystic medial necrosis) / Fibromuscular Dysplasia || +2 | |||
|- | |||
| Youth/<50 year || +1 | |||
|- | |||
| Estroprogestinic therapy || +1 | |||
|- | |||
| No classical coronary risk factors || +1 | |||
|- | |||
| Pregnancy (peri-partum, history of multiple pregnancy)/ Female gender || +1 | |||
|- | |||
| History of coronary artery spasm/ previous SCAD || +3 | |||
|- | |||
| Amphetamines/Cocaine/Vasospastic drug abuse || +1 | |||
|- | |||
| Systematic inflammation (SLE, Chron disease, sarcoidosis, polyarteritis nodosa, Behcet's syndrome || +2 | |||
|- | |||
| Emotional/ Physical stress || +1 | |||
|- | |||
! colspan="2" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Angiographic Characteristics}} | |||
|- | |||
| One vessel disease (no typical atherosclerotic lesions in order coronary arteries) || +1 | |||
|- | |||
| Long/tortuose suspected lesion || +1 | |||
|- | |||
| Diffuse, typically smooth arterial narrowing || +1 | |||
|- | |||
| colspan="2" | '''At least 3 points:''' Indication to perform endovascular imaging (OCT or, if not available, IVUS) | |||
|- | |||
| colspan="2" | In the presence of a score of at least three points in a patient presenting with chest pain, ECG/Echo abnormalities or troponin rise/fall, perform OCT/IVUS analysis for suspected SCAD. | |||
|} | |||
==References== | ==References== | ||
Revision as of 22:58, 26 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
Differential Diagnosis
While Type 1 SCAD has a pathognomonic appearance on angiography, Type 2 may be and Type 3 typically is indistinguishable from atherosclerosis. Risk factors and patient history may help determine diagnosis. Intracoronary imaging provides the most objective tool in differentiating between SCAD and atheroma.[1]
| Clinical-Angiographic Score System for SCAD Faster Diagnosis | |
|---|---|
| Clinical Characteristics | |
| Connective tissue disorder (Marfan syndrome, Ehler-Danlos syndrome, cystic medial necrosis) / Fibromuscular Dysplasia | +2 |
| Youth/<50 year | +1 |
| Estroprogestinic therapy | +1 |
| No classical coronary risk factors | +1 |
| Pregnancy (peri-partum, history of multiple pregnancy)/ Female gender | +1 |
| History of coronary artery spasm/ previous SCAD | +3 |
| Amphetamines/Cocaine/Vasospastic drug abuse | +1 |
| Systematic inflammation (SLE, Chron disease, sarcoidosis, polyarteritis nodosa, Behcet's syndrome | +2 |
| Emotional/ Physical stress | +1 |
| Angiographic Characteristics | |
| One vessel disease (no typical atherosclerotic lesions in order coronary arteries) | +1 |
| Long/tortuose suspected lesion | +1 |
| Diffuse, typically smooth arterial narrowing | +1 |
| At least 3 points: Indication to perform endovascular imaging (OCT or, if not available, IVUS) | |
| In the presence of a score of at least three points in a patient presenting with chest pain, ECG/Echo abnormalities or troponin rise/fall, perform OCT/IVUS analysis for suspected SCAD. | |
References
- ↑ Yip A, Saw J (2015). "Spontaneous coronary artery dissection-A review". Cardiovasc Diagn Ther. 5 (1): 37–48. doi:10.3978/j.issn.2223-3652.2015.01.08. PMC 4329168. PMID 25774346.