Spontaneous coronary artery dissection differential diagnosis
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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
Spontaneous coronary artery dissection should be differentiated from other causes of acute coronary syndrome. Features suggestive of spontaneous coronary artery dissection include myocardial infarction in young women (age ≤50), absence of traditional cardiovascular risk factors, little or no evidence of coronary atherosclerosis, peripartum state, history of fibromuscular dysplasia, and history of connective tissue disorder or systemic inflammatory disorder.
Differential Diagnosis
Albeit an infrequent condition, spontaneous coronary artery dissection (SCAD) should be included in the differential diagnosis of acute coronary syndrome, particularly among young women with risk factors such as vasculopathy, pregnancy, connective tissue disorder, systemic inflammation, strenuous exercise, emotional stress, or recreational drug use. While demographic and angiographic characteristics may be useful in differentiating SCAD from other causes of myocardial ischemia, intracoronary imaging such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) may be required for establishing a definitive diagnosis.
===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===[1][2][3][4][5][6]
| Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Physical examination | ||||||||||||||
| Lab Findings | Imaging | Histopathology | |||||||||||||
| Symptom 1 | Symptom 2 | Symptom 3 | Physical exam 1 | Physical exam 2 | Physical exam 3 | Lab 1 | Lab 2 | Lab 3 | Imaging 1 | Imaging 2 | Imaging 3 | ||||
| STEMI | Chest discomfort radiated to arms, neck, back, jaw | Shortness of breath, dizziness, faintness | Nausea, vomiting, sweating | Tachycardia, bradycardia | Hypertension, hypotension, syncope | S4 heart sound, rale, holosystolic murmur in apex | ↑Troponin I, T | ↑Creatin kinase MB (CKMB) | ↑C-reactive protein, BNP | Occlusive coronary thrombus formation superimposed on a ruptured or eroded atherosclerotic plaque | Coronary angiography | ||||
| Spontaneous coronary artery dissection | Chest discomfort radiated to arms, neck, back, jaw | Shortness of breath, dizziness, faintness | Nausea, vomiting, sweating | Tachycardia, bradycardia | Hypertension, hypotension, syncope | rale, holosystolic murmur in apex | ↑Troponin I, T | ↑Creatin kinase MB (CKMB) | Coronary angiography | intravascular ultrasound (IVUS), optical coherence tomography (OCT) | Coronary CT angiography | Separation of the coronary artery wall layers, intramural space (false lumen), communicating with the true lumen via intimal tear (flap fenestration), myoendothelial tissue lamina (intimomedial flap) dividing the two vascular spaces, haemorrhage within the tunica media and adventitia | Intracoronary imaging such as intravascular ultrasound (IVUS), optical coherence tomography (OCT) | Mimicing ECG changes of STMI | |
| Coronary vasospasm | Chest discomfort radiated to arms, neck, back, jaw | Shortness of breath, dizziness, faintness | Nausea, vomiting, sweating | Tachycardia, bradycardia | Hypertension, hypotension, syncope | Rale, holosystolic murmur in apex | ↑Troponin I, T | ↑Creatin kinase MB (CKMB) | IVUS findings: negative remodeling, diffuse intima, thick media, and wrinkles in the internal elastic membrane even in the absence of a significant coronary stenosis | Morphologic changes in the artery at the site of the spasm, endothelium damaged, Platelets aggregation at this site releasing vasoactive substances, thrombin formation | Coronary angiography and spasm provocation test | occurring most often from midnight to early morning, Mimicing ECG changes of STMI | |||
| Diseases | symptom1 | symptom2 | symptom3 | Physical exam 1 | Physical exam 2 | Physical exam 3 | Lab 1 | Lab 2 | Lab 3 | Imaging 1 | Imaging 2 | Imaging 3 | Histopathology | Gold standard | Additional findings |
| Differential Diagnosis 4 | |||||||||||||||
| Differential Diagnosis 5 | |||||||||||||||
| Differential Diagnosis 6 | |||||||||||||||
References
- ↑ Paulo, Manuel; Sandoval, Jorge; Lennie, Vera; Dutary, Jaime; Medina, Miguel; Gonzalo, Nieves; Jimenez-Quevedo, Pilar; Escaned, Javier; Bañuelos, Camino; Hernandez, Rosana; Macaya, Carlos; Alfonso, Fernando (2013). "Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection". JACC: Cardiovascular Imaging. 6 (7): 830–832. doi:10.1016/j.jcmg.2013.02.010. ISSN 1936-878X.
- ↑ Adlam, David; Alfonso, Fernando; Maas, Angela; Vrints, Christiaan; al-Hussaini, Abtehale; Bueno, Hector; Capranzano, Piera; Gevaert, Sofie; Hoole, Stephen P; Johnson, Tom; Lettieri, Corrado; Maeder, Micha T; Motreff, Pascal; Ong, Peter; Persu, Alexandre; Rickli, Hans; Schiele, Francois; Sheppard, Mary N; Swahn, Eva (2018). "European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection". European Heart Journal. 39 (36): 3353–3368. doi:10.1093/eurheartj/ehy080. ISSN 0195-668X.
- ↑ . doi:10.1136/2Fhrt.53.4.363. Missing or empty
|title=(help) - ↑ Davies, Michael J. (1996). "The contribution of thrombosis to the clinical expression of coronary atherosclerosis". Thrombosis Research. 82 (1): 1–32. doi:10.1016/0049-3848(96)00035-7. ISSN 0049-3848.
- ↑ YASUE, Hirofumi; MIZUNO, Yuji; HARADA, Eisaku (2019). "Coronary artery spasm — Clinical features, pathogenesis and treatment —". Proceedings of the Japan Academy, Series B. 95 (2): 53–66. doi:10.2183/pjab.95.005. ISSN 0386-2208.
- ↑ Shepherd, John T.; Vanhoutte, Paul M. (1985). "Spasm of the Coronary Arteries: Causes and Consequences (the Scientist's Viewpoint)". Mayo Clinic Proceedings. 60 (1): 33–46. doi:10.1016/S0025-6196(12)65280-X. ISSN 0025-6196.