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Presence of features that raise | Presence of features that raise suspicion for SCAD?<BR><span style="color: #0645AD;">(click for details)</span> | ||
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Perform early coronary angiography | Perform early coronary angiography | ||
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Presence of type 1 SCAD lesion characteristics? <span style="color: #0645AD;">(click for details)</span> | Presence of type 1 SCAD lesion characteristics?<BR><span style="color: #0645AD;">(click for details)</span> | ||
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E01=<div style="text-align: center; font-weight: bold; padding: 5px;">Type 1 SCAD</div>| | |||
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Presence of type 2 SCAD lesion characteristics?<BR><span style="color: #0645AD;">(click for details)</span> | |||
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❑ Diffuse lesion (typically >20–30 mm) | |||
❑ Smooth luminal narrowing with varying severity | |||
❑ Involvement of mid to distal segments | |||
❑ Type 2A: normal coronary segments proximal and distal to lesion | |||
❑ Type 2B: extension to apical tip without normal segment distally | |||
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G01=<div style="text-align: left; font-weight: bold; padding: 5px;">Stenosis relieved by intracoronary nitroglycerin?</div>| | |||
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Look for type 3 SCAD lesion characteristics<BR><span style="color: #0645AD;">(click for details)</span> | |||
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❑ Focal or tubular stenosis (typically <20 mm) | |||
❑ Mimics atherosclerosis | |||
❑ Additional features | |||
❑ Lack of atherosclerosis in other coronary arteries | |||
❑ Long lesions (11–20 mm) | |||
❑ Hazy stenosis | |||
❑ Linear stenosis | |||
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Revision as of 17:53, 28 November 2017
Spontaneous Coronary Artery Dissection Microchapters |
Differentiating Spontaneous coronary artery dissection from other Diseases |
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Diagnosis |
Treatment |
Case Studies |
Type 1 Type 2A Type 2B Type 3 |
Algorithm for the Angiographic Diagnosis and Confirmation of Spontaneous Coronary Artery Dissection[1]
Presence of features that raise suspicion for SCAD? ❑ Myocardial infarction in young women (especially age ≤50) ❑ Absence of traditional cardiovascular risk factors ❑ Little or no evidence of typical atherosclerotic lesions in coronary arteries ❑ History of fibromuscular dysplasia ❑ History of relevant connective tissue disorder or systemic inflammatory condition ❑ Ehlers-Danlos syndrome Type 4 ❑ Systemic lupus erythematosus | |||||||||||||||||||||||||||||||
Perform early coronary angiography | |||||||||||||||||||||||||||||||
Presence of type 1 SCAD lesion characteristics? ❑ Pathognomonic appearance of contrast dye staining of arterial wall ❑ Multiple radiolucent lumens ❑ ±Dye hang-up or slow contrast clearing from the lumen | |||||||||||||||||||||||||||||||
YES | NO | ||||||||||||||||||||||||||||||
Type 1 SCAD | Presence of type 2 SCAD lesion characteristics? ❑ Diffuse lesion (typically >20–30 mm) ❑ Smooth luminal narrowing with varying severity ❑ Involvement of mid to distal segments ❑ Type 2A: normal coronary segments proximal and distal to lesion ❑ Type 2B: extension to apical tip without normal segment distally | ||||||||||||||||||||||||||||||
YES | NO | ||||||||||||||||||||||||||||||
Stenosis relieved by intracoronary nitroglycerin? | Look for type 3 SCAD lesion characteristics ❑ Focal or tubular stenosis (typically <20 mm) ❑ Mimics atherosclerosis ❑ Additional features ❑ Lack of atherosclerosis in other coronary arteries ❑ Long lesions (11–20 mm) ❑ Hazy stenosis ❑ Linear stenosis | ||||||||||||||||||||||||||||||
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References
- ↑ Saw J (2014). "Coronary angiogram classification of spontaneous coronary artery dissection". Catheter Cardiovasc Interv. 84 (7): 1115–22. doi:10.1002/ccd.25293. PMID 24227590.