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><ref name="BuccheriPiraino2016">{{cite journal|last1=Buccheri|first1=Dario|last2=Piraino|first2=Davide|last3=Latini|first3=Roberto A.|last4=Andolina|first4=Giuseppe|last5=Cortese|first5=Bernardo|title=Spontaneous coronary artery dissections: A call for action for an underestimated entity|journal=International Journal of Cardiology|volume=214|year=2016|pages=333–335|issn=01675273|doi=10.1016/j.ijcard.2016.03.131}}</ref> | ||
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Revision as of 16:39, 30 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: Arzu Kalayci, M.D. [2]
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][2]
| 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. [3] | |
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.
- ↑ Buccheri, Dario; Piraino, Davide; Latini, Roberto A.; Andolina, Giuseppe; Cortese, Bernardo (2016). "Spontaneous coronary artery dissections: A call for action for an underestimated entity". International Journal of Cardiology. 214: 333–335. doi:10.1016/j.ijcard.2016.03.131. ISSN 0167-5273.
- ↑ Buccheri D, Zambelli G (2016). "Focusing on spontaneous coronary artery dissection: actuality and future perspectives". J Thorac Dis. 8 (12): E1784–E1786. doi:10.21037/jtd.2016.12.79. PMC 5227193. PMID 28149642.