Spontaneous coronary artery dissection differential diagnosis: Difference between revisions

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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>
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>


{| 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. <ref name="pmid28149642">{{cite journal| author=Buccheri D, Zambelli G| title=Focusing on spontaneous coronary artery dissection: actuality and future perspectives. | journal=J Thorac Dis | year= 2016 | volume= 8 | issue= 12 | pages= E1784-E1786 | pmid=28149642 | doi=10.21037/jtd.2016.12.79 | pmc=5227193 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28149642  }} </ref>
|}


==References==
==References==

Revision as of 19:35, 30 November 2017

Spontaneous Coronary Artery Dissection Microchapters

Home

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Spontaneous coronary artery dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Angiography

CT

MRI

Echocardiography

Other Imaging Findings

Other Diagnostic Studies

Treatment

Treatment Approach

Medical Therapy

Percutaneous Coronary Intervention

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

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]


References

  1. ↑ 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.
  2. ↑ 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.
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