Spontaneous coronary artery dissection treatment approach: Difference between revisions
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** [[Beta-blocker]] therapy | ** [[Beta-blocker]] therapy | ||
** Management of [[hypertension]] | ** Management of [[hypertension]] | ||
** Maintaining | ** Maintaining physical activity | ||
==Assessment of [[Vascular]] Abnormalities== | |||
* To identify [[patients]] with SCAD-associated conditions, [[imaging]] with [[CT angiography]] or [[magnetic resonance angiography]] is recommended.<ref name="KimLongo2020">{{cite journal|last1=Kim|first1=Esther S.H.|last2=Longo|first2=Dan L.|title=Spontaneous Coronary-Artery Dissection|journal=New England Journal of Medicine|volume=383|issue=24|year=2020|pages=2358–2370|issn=0028-4793|doi=10.1056/NEJMra2001524}}</ref> | |||
===Improvement in Quality of life=== | |||
* To improve the quality of life in [[patients]] with SCAD, consider:<ref name="KimLongo2020">{{cite journal|last1=Kim|first1=Esther S.H.|last2=Longo|first2=Dan L.|title=Spontaneous Coronary-Artery Dissection|journal=New England Journal of Medicine|volume=383|issue=24|year=2020|pages=2358–2370|issn=0028-4793|doi=10.1056/NEJMra2001524}}</ref> | |||
**[[Cardiac rehabilitation]] referral | |||
** Manage patients comorbidities | |||
==Algorithm for management of acute spontaneous coronary artery dissection: A Scientific Statement From the American Heart Association== | ==Algorithm for management of acute spontaneous coronary artery dissection: A Scientific Statement From the American Heart Association== | ||
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{{Familytree | | | C01 | | | | C02 | | | | C03 | | |C01=<div style="text-align: left; padding: 5px;">❑ Conservative therapy<BR>❑ Monitor as inpatient 3–5 days</div>|C02=<div style="text-align: left; padding: 5px;">❑ Consider CABG<BR>❑ Conservative Rx may be reasonable</div>|C03=<div style="text-align: left; padding: 5px;">❑ Consider PCI if feasible, OR<BR>❑ Urgent CABG (based on technical considerations and local expertise)</div>}} | {{Familytree | | | C01 | | | | C02 | | | | C03 | | |C01=<div style="text-align: left; padding: 5px;">❑ Conservative therapy<BR>❑ Monitor as inpatient 3–5 days</div>|C02=<div style="text-align: left; padding: 5px;">❑ Consider CABG<BR>❑ Conservative Rx may be reasonable</div>|C03=<div style="text-align: left; padding: 5px;">❑ Consider PCI if feasible, OR<BR>❑ Urgent CABG (based on technical considerations and local expertise)</div>}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
<span style="font-size: 100%;"> | <span style="font-size: 100%;"> | ||
'''Abbreviations''': | '''Abbreviations''': | ||
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Rx, management. | Rx, management. | ||
</span> | </span> | ||
</div> | </div> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Angiographic Definitions]] | [[Category:Angiographic Definitions]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Revision as of 04:42, 2 February 2021
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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: Nate Michalak, B.A.
Synonyms and keywords: SCAD
Overview
Treatment Approach
- Pharmacologic medical therapies for spontaneous coronary artery dissection pursues three main goals:[1]
- Antianginal therapy
- Prevention of recurrence
- Assessment and management of extra coronary vascular abnormalities
- Improvement of quality of life
Management of Chest Pain
- To manage of chest pain in patients with SCAD consider the followings:[1]
- Antianginal medications
- Consider further testing to rule out underlying ischemia
- Consider other possible diagnoses
Prevention
- To reduce the risk of SCAD recurrence, the following should be considered:[1]
- Beta-blocker therapy
- Management of hypertension
- Maintaining physical activity
Assessment of Vascular Abnormalities
- To identify patients with SCAD-associated conditions, imaging with CT angiography or magnetic resonance angiography is recommended.[1]
Improvement in Quality of life
- To improve the quality of life in patients with SCAD, consider:[1]
- Cardiac rehabilitation referral
- Manage patients comorbidities
Algorithm for management of acute spontaneous coronary artery dissection: A Scientific Statement From the American Heart Association
Algorithm for management of acute spontaneous coronary artery dissection.[2]
Management of Acute Spontaneous Coronary Artery Dissection | |||||||||||||||||||||||||||||||||||||||
| Clinically stable without high-risk anatomy | Clinically stable with high-risk anatomy (i.e., left main or proximal 2-vessel dissection) | Active/ongoing ischemia or hemodynamic instability | |||||||||||||||||||||||||||||||||||||
❑ Conservative therapy ❑ Monitor as inpatient 3–5 days | ❑ Consider CABG ❑ Conservative Rx may be reasonable | ❑ Consider PCI if feasible, OR ❑ Urgent CABG (based on technical considerations and local expertise) | |||||||||||||||||||||||||||||||||||||
Abbreviations: CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention; Rx, management.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Kim, Esther S.H.; Longo, Dan L. (2020). "Spontaneous Coronary-Artery Dissection". New England Journal of Medicine. 383 (24): 2358–2370. doi:10.1056/NEJMra2001524. ISSN 0028-4793.
- ↑ Hayes, Sharonne N.; Kim, Esther S.H.; Saw, Jacqueline; Adlam, David; Arslanian-Engoren, Cynthia; Economy, Katherine E.; Ganesh, Santhi K.; Gulati, Rajiv; Lindsay, Mark E.; Mieres, Jennifer H.; Naderi, Sahar; Shah, Svati; Thaler, David E.; Tweet, Marysia S.; Wood, Malissa J. (2018). "Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association". Circulation: CIR.0000000000000564. doi:10.1161/CIR.0000000000000564. ISSN 0009-7322.