Spontaneous coronary artery dissection diagnostic approach: Difference between revisions
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/* Management Algorithm for Spontaneous Coronary Artery Dissection {{cite journal| author=Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS et al.| title=Spontaneous coronary artery dissection: revascularization versus conservative therapy. |... |
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{{familytree | | | |!| | | | | |!| | | |!| | | | | | | |!| | | | | |!|}} | {{familytree | | | |!| | | | | |!| | | |!| | | | | | | |!| | | | | |!|}} | ||
{{familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | |!| | | | | F01 | | F02 | | | | | | F03 |-|-|-|-|'| F01= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 30px;">Isolated Left Main</div>|F02= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">Involving Left Anterior Descending (LAD +/or circumflex</div>| F03= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 30px;">Is percutaneous coronary intervention (PCI) feasible?</div>}} | {{familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | |!| | | | | F01 | | F02 | | | | | | F03 |-|-|-|-|'| F01= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 30px;">Isolated Left Main</div>|F02= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 10px;">Involving Left Anterior Descending (LAD +/or circumflex)</div>| F03= <div style="text-align: center; background: #FFFFFF; font-weight: bold; padding: 30px;">Is percutaneous coronary intervention (PCI) feasible?</div>}} | ||
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Revision as of 19:55, 26 February 2018
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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
Diagnostic Approach
Management Algorithm for Spontaneous Coronary Artery Dissection [1]
Spontaneous Coronary Artery Dissection (SCAD) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Stable, no high-risk feature (i.e., left main or proximal 2-vessel coronary artery dissection) | High-risk feature present | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Left main dissection | Ongoing/recurrent ischemia | Ventricular tachycardia or fibrillation | Cardiogenic shock | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hemodynamically unstable? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Consider: Intra-aortic balloon pump, Extra corporeal membrane oxygenation, Left ventricular assist device, Implantable cardioverter defibrillator | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Isolated Left Main | Involving Left Anterior Descending (LAD +/or circumflex) | Is percutaneous coronary intervention (PCI) feasible? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ostial LAD or ≥ 2 proximal SCAD? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Conservative therapy | PCI | Coronary artery bypassing | Conservative therapy | PCI | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adjunctive medical therapy Aspirin and beta-blocker (± clopidogrel, ACEI/ARB, statin) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Monitor in-hospital for 3 to 5 days | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS; et al. (2014). "Spontaneous coronary artery dissection: revascularization versus conservative therapy". Circ Cardiovasc Interv. 7 (6): 777–86. doi:10.1161/CIRCINTERVENTIONS.114.001659. PMID 25406203.