Spontaneous coronary artery dissection screening

Spontaneous Coronary Artery Dissection Microchapters
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Overview
Historical Perspective
Classification
Pathophysiology
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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
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Treatment
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Medical Therapy
Percutaneous Coronary Intervention
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Type 1 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Type 2A Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Type 2B Case 1 Case 2 Case 3 Case 4 Type 3 Case 1 Case 2 Case 3 Case 4 Case 5 Case 6

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

SCAD usually is the result of an underlying vascular or connective tissue disorders. In order to provide the best care to patients with SCAD, the scientific statement from the American Heart Association (AHA) recommended a detailed review of systems and personal and family history of SCAD-associated symptoms and conditions. In addition, AHA scientific statement recommended a complete vascular exam. Routine clinical or genetic screening of asymptomatic relatives of patients with SCAD is not recommended. However, genetic screening is recommended in first-degree family members of patients with SCAD in whom a monogenic vascular disease has been identified.

Screening

SCAD usually is the result of an underlying vascular or connective tissue disorders. In order to provide the best care to patients with SCAD, the scientific statement from the American Heart Association (AHA) recommended a detailed review of systems and personal and family history of SCAD-associated symptoms and conditions.
In addition, AHA scientific statement recommended a complete vascular exam with palpation and auscultation of the following arteries:

• Abdominal aorta
• Cervical carotid arteries
• Peripheral arteries of the upper and lower extremities

Screening Questions

AHA scientific statement recommended a list of questions to rule out SCAD-associated vasculopathy and connective tissue disorders:

Screening Questions:

Personal history of the following conditions: ❑ Early-onset hypertension ❑ Stroke or transient ischemic attack ❑ Pulsatile tinnitus ❑ Migraine headaches ❑ Renal infarction ❑ Subarachnoid hemorrhage ❑ Aneurysm (aortic, peripheral, brain) ❑ Dissection (aortic, peripheral) ❑ Rupture of hollow organs (intestinal, bladder, uterine) ❑ Pneumothorax ❑ Tendon or muscle rupture ❑ Joint dislocation ❑ Talipes equinovarus (clubfoot) ❑ Umbilical or inguinal hernia ❑ Scoliosis or pectus deformity ❑ Pregnancy complications (cervical incompetence, hemorrhage, uterine prolapse, hypertension) ❑ Poor wound healing ❑ Ectopia lentis ❑ Myopia ❑ Detached retina, early glaucoma, or early cataracts ❑ Tall stature ❑ Abnormality of cardiac valve (bicuspid aortic valve, mitral valve prolapse) ❑ Systemic inflammatory disease Family history of the following conditions: ❑ Dissection (coronary, aortic, peripheral) ❑ Inherited arteriopathy or connective tissue disorder (eg, vascular Ehlers-Danlos syndrome, Marfan syndrome, Loeys-Dietz syndrome) ❑ Fibromuscular dysplasia ❑ Aneurysm (aortic, peripheral, brain) ❑ Early stroke, early myocardial infarction, sudden cardiac death Review of systems (history of any of the following symptoms) ❑ Headaches ❑ Pulsatile tinnitus ❑ Postprandial abdominal pain ❑ Flank pain ❑ Claudication ❑ Easy bruising ❑ Joint hypermobility or laxity

The above table adopted from AHA scientific statement

Genetic Screening of Family Members

• Genetic screening is recommended in first-degree family members of patients with SCAD in whom a monogenic vascular disease has been identified.
• Routine clinical or genetic screening of asymptomatic relatives of patients with SCAD is not recommended.