|
|
Line 1: |
Line 1: |
| __NOTOC__
| | 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> |
| {{Spontaneous coronary artery dissection}}
| |
| | |
| {| class="wikitable" style="font-size: 85%;"
| |
| ! style="background: #4479BA; text-align: center; width: 150px;" |{{fontcolor|#FFF|Potential factor}}
| |
| ! style="background: #4479BA; text-align: center; width: 850px;" colspan=2 | {{fontcolor|#FFF|Condition}}
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Predisposing causes'''
| |
| | style="background: #F5F5F5; padding: 5px;" colspan="2;"|
| |
| * Fibromuscular dysplasia
| |
| * Pregnancy-related: antepartum, early post-partum, late post- partum, very late post-partum
| |
| * Recurrent pregnancies: multiparity or multigravida
| |
| * Connective tissue disorder: Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome type 4, cystic medial necrosis, alpha-1 antitrypsin deficiency, polycystic kidney disease
| |
| * Systemic inflammatory disease: systemic lupus erythematosus, Crohn’s disease, ulcerative colitis, polyarteritis nodosa, sarcoidosis, Churg-Strauss syndrome, Wegener's granulomatosis, rheumatoid arthritis, Kawasaki disease, giant cell arteritis, celiac disease
| |
| * Hormonal therapy: oral contraceptive, estrogen, progesterone, beta-HCG, testosterone, corticosteroids
| |
| * Coronary artery spasm
| |
| * Idiopathic
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Precipitating stressors'''
| |
| | style="background: #F5F5F5; padding: 5px;" colspan="2;"|
| |
| * Intense exercises including isometric or aerobic activities
| |
| * Intense emotional stress
| |
| * Labor and delivery
| |
| * Intense Valsava-type activities: retching, vomiting, bowel movement, coughing
| |
| * Recreational drugs: cocaine, amphetamines, metamphetamines
| |
| * Intense hormonal therapy: beta-HCG injections, corticosteroids injections
| |
| |}
| |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| <!---
| |
| <div style="font-size: 80%;" align="center">
| |
| | |
| <span style="font-size: 1.5em; font-weight: bold;">Algorithm for the Angiographic Diagnosis and Confirmation of Spontaneous Coronary Artery Dissection</span><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><BR><BR>
| |
| | |
| {{Familytree/start}}
| |
| {{Familytree | | | | | A01 | | | | | | | | |
| |
| A01=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| <div class="mw-customtoggle-x1" style="cursor: pointer;>
| |
| Presence of features that raise suspicion for SCAD?<BR><span style="color: #0645AD;">(click for details)</span>
| |
| </div>
| |
| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x1" style="font-size: 10px;">
| |
| ----
| |
| ❑ [[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]]
| |
| | |
| ❑ [[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]]
| |
| ----
| |
| </div>
| |
| </div>}}
| |
| {{Familytree | | | | | |!| | | | | | | | | | }} | |
| {{Familytree | | | | | B01 | | | | | | | | |
| |
| B01=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| Perform early coronary angiography
| |
| </div>}}
| |
| {{Familytree | | | | | |!| | | | | | | | | | }}
| |
| {{Familytree | | | | | C01 | | | | | | | | |
| |
| C01=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| <div class="mw-customtoggle-x2" style="cursor: pointer;>
| |
| Presence of type 1 SCAD lesion characteristics?<BR><span style="color: #0645AD;">(click for details)</span>
| |
| </div>
| |
| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x2" style="font-size: 10px;">
| |
| ----
| |
| ❑ Contrast staining of arterial wall
| |
| | |
| ❑ Multiple radiolucent lumens
| |
| | |
| ❑ Contrast hang-up or slow clearing from the lumen
| |
| ----
| |
| </div>
| |
| </div>}}
| |
| {{Familytree | |,|-|-|-|^|-|-|-|.| | | | | | }}
| |
| {{Familytree | D01 | | | | | | D02 | | | | |
| |
| D01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
| |
| D02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>
| |
| }}
| |
| {{Familytree | |!| | | | | | | |!| | | | | | }}
| |
| {{Familytree | E01 | | | | | | E02 | | | | |
| |
| E01=<div style="text-align: left; font-weight: bold; padding: 5px;">Type 1 SCAD most likely</div>|
| |
| E02=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| <div class="mw-customtoggle-x3" style="cursor: pointer;>
| |
| Presence of type 2 SCAD lesion characteristics?<BR><span style="color: #0645AD;">(click for details)</span>
| |
| </div>
| |
| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x3" style="font-size: 10px;">
| |
| ----
| |
| ❑ Diffuse lesion (typically >20–30 mm)
| |
|
| |
| ❑ Smooth luminal narrowing with varying severity
| |
| | |
| ❑ Involvement of mid to distal segments
| |
| ----
| |
| </div>
| |
| </div>
| |
| }}
| |
| {{Familytree | | | | | |,|-|-|-|^|-|-|-|.| | }}
| |
| {{Familytree | | | | | F01 | | | | | | F02 |
| |
| F01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
| |
| F02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>
| |
| }}
| |
| {{Familytree | | | | | |!| | | | | | | |!| | }}
| |
| {{Familytree | | | | | G01 | | | | | | G02 |
| |
| G01=<div style="text-align: left; font-weight: bold; padding: 5px;">Stenosis relieved by intracoronary nitroglycerin?</div>|
| |
| G02=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| <div class="mw-customtoggle-x4" style="cursor: pointer;>
| |
| Look for type 3 SCAD lesion characteristics<BR><span style="color: #0645AD;">(click for details)</span>
| |
| </div>
| |
| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x4" style="font-size: 10px;">
| |
| ----
| |
| ❑ Focal or tubular stenosis (typically <20 mm)
| |
|
| |
| ❑ Mimics atherosclerosis
| |
| | |
| ❑ Additional features
| |
| | |
| ❑ No atherosclerosis in other arteries
| |
| | |
| ❑ Long lesions (11–20 mm)
| |
| | |
| ❑ Hazy stenosis
| |
| | |
| ❑ Linear stenosis
| |
| ----
| |
| </div>
| |
| </div>
| |
| }}
| |
| {{Familytree | |,|-|-|-|^|-|-|-|.| | | |!| | }}
| |
| {{Familytree | H01 | | | | | | H02 | | H03 |
| |
| H01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
| |
| H02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>|
| |
| H03=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| Type 3 SCAD most likely
| |
| | |
| ❑ Consider OCT or IVUS for definitive diagnosis
| |
| | |
| ❑ Reassess with angiography in 4 to 6 weeks
| |
| </div>
| |
| }}
| |
| {{Familytree | |!| | | | | | | |!| | | | | | }}
| |
| {{Familytree | I01 | | | | | | I02 | | | | |
| |
| I01=<div style="text-align: left; font-weight: bold; padding: 5px;">R/O coronary spasm or other conditions</div>|
| |
| I02=<div style="text-align: left; font-weight: bold; padding: 5px;">
| |
| Type 2 SCAD most likely
| |
| | |
| ❑ Consider OCT or IVUS for definitive diagnosis
| |
| | |
| ❑ Reassess with angiography in 4 to 6 weeks
| |
| </div>}}
| |
| {{Family tree/end}}
| |
| </div> | |
| | |
| ==References==
| |
| {{reflist|2}}
| |