Spontaneous coronary artery dissection treatment approach: Difference between revisions
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==Acute Management== | ==Acute Management== | ||
*Acute management of [[myocardial infarction]] in SCAD is medical therapy in approximately 80% of the [[patients]]. [[Myocardial infarction]] in the context of SCAD is different from the [[myocardial infarction]] in the context of [[atherosclerosis]] and therefore makes it unfavorable for [[revascularization]] approaches.<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> | *Acute management of [[myocardial infarction]] in SCAD is medical therapy in approximately 80% of the [[patients]]. [[Myocardial infarction]] in the context of SCAD is different from the [[myocardial infarction]] in the context of [[atherosclerosis]] and therefore makes it unfavorable for [[revascularization]] approaches.<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> | ||
*[[Percuatenous coronary intervention]] ([[PCI]]) can be considered in high risk [[patients]], such as: | |||
**[[Patients]] with following clinical presentations: | |||
***Persistent [[chest pain]] with evidence of worsening [[ischemia]] | |||
***[[Hemodynamic instability]] | |||
***[[Shock]] | |||
***[[Ventricular]] [[arrhythmias]] | |||
==Long-Term Treatment Approach== | ==Long-Term Treatment Approach== | ||
* Long-term treatment for spontaneous coronary artery dissection pursues several main goals:<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> | * Long-term treatment for spontaneous coronary artery dissection pursues several main goals:<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> | ||
Revision as of 05:11, 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
Long-term treatment for spontaneous coronary artery dissection pursues several main goals including antianginal therapy, prevention of recurrence, assessment, and management of extra coronary vascular abnormalities, and improvement of quality of life.
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.[1]
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.
Acute Management
- Acute management of myocardial infarction in SCAD is medical therapy in approximately 80% of the patients. Myocardial infarction in the context of SCAD is different from the myocardial infarction in the context of atherosclerosis and therefore makes it unfavorable for revascularization approaches.[2]
- Percuatenous coronary intervention (PCI) can be considered in high risk patients, such as:
- Patients with following clinical presentations:
- Persistent chest pain with evidence of worsening ischemia
- Hemodynamic instability
- Shock
- Ventricular arrhythmias
- Patients with following clinical presentations:
Long-Term Treatment Approach
- Long-term treatment for spontaneous coronary artery dissection pursues several main goals:[2]
- 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:[2]
- 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:[2]
- 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.[2]
Improvement in Quality of life
- To improve the quality of life in patients with SCAD, consider:[2]
- Cardiac rehabilitation referral
- Manage patients comorbidities
References
- ↑ 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.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 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.