Coronary artery dissection: Difference between revisions
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==Background== | ==Background== | ||
[[File:RevisedSCAD.png|thumb|Illustration showing coronary artery dissection with formation of a hematoma (purple) within the walls of the coronary artery.]] | |||
*Spontaneous tear in the intimal wall of a coronary artery leading to a false lumen and intramural hematoma, similar to [[aortic dissection]] | |||
*Much more common in young women | |||
===Causes=== | |||
*Hormonal changes in vessel wall (eg pregnancy, contraceptives) | |||
*Shear forces | |||
*Fibromuscular dysplasia | |||
*Underling [[connective tissue disorder]] | |||
*Iatrogenic (during coronary angiography) | |||
==Clinical Features== | ==Clinical Features== | ||
*[[Chest pain|Chest]] or shoulder pain | |||
*[[Syncope]] | |||
*[[Dyspnea]] | |||
*Diaphoresis | |||
*[[Nausea]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ST elevation DDX}} | |||
==Workup== | ==Evaluation== | ||
[[File:PMC3424780 HV-13-53-g003.png|thumb|ECG showing ST elevation in the antero-lateral leads in a patient with coronary artery dissection.]] | |||
===Workup=== | |||
*[[EKG]] | |||
**Usually presents as an Anterior MI with ST changes in anterior Precordial leads (V1-V3) | |||
*Basic labs, including [[troponin]] | |||
*[[Echocardiography]] | |||
===Diagnosis=== | |||
*[[EKG]] usually shows an Anterior MI with ST changes in anterior Precordial leads (V1-V3) | |||
*[[Troponin]] may be elevated | |||
*Definitive diagnosis made at time of coronary angiography | |||
==Management== | ==Management== | ||
*[[Aspirin]], [[beta-blockers|β-blocker]], and 1 year of [[clopidogrel]]<ref>Saw J, Aymong E, Sedlak T, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv 2014; 7:645.</ref> | |||
*Cardiology consultation | |||
**PCI can be challenging given vessel wall fragility | |||
==Disposition== | ==Disposition== | ||
*Admit | |||
==See Also== | ==See Also== | ||
*[[Chest Pain]] | |||
*[[ST-segment_elevation_myocardial_infarction_(STEMI)|STEMI]] | |||
== | ==External Links== | ||
*[https://rebelem.com/spontaneous-coronary-artery-dissection-scad/ Rebel EM - Spontaneous Coronary Artery Dissection] | |||
==References== | |||
<references/> | <references/> | ||
[[Category:Cardiology]] | |||
Latest revision as of 22:53, 1 July 2021
Background
- Spontaneous tear in the intimal wall of a coronary artery leading to a false lumen and intramural hematoma, similar to aortic dissection
- Much more common in young women
Causes
- Hormonal changes in vessel wall (eg pregnancy, contraceptives)
- Shear forces
- Fibromuscular dysplasia
- Underling connective tissue disorder
- Iatrogenic (during coronary angiography)
Clinical Features
Differential Diagnosis
ST Elevation
- Cardiac
- ST-segment elevation myocardial infarction (STEMI)
- Post-MI (ventricular aneurysm pattern)
- Previous MI with recurrent ischemia in same area
- Wellens' syndrome
- Coronary artery vasospasm (eg, Prinzmetal's angina)
- Coronary artery dissection
- Pericarditis
- Myocarditis
- Aortic dissection in to coronary
- Left ventricular aneurysm
- Left ventricular pseudoaneurysm
- Early repolarization
- Left bundle branch block
- Left ventricular hypertrophy (LVH)
- Myocardial tumor
- Myocardial trauma
- RV pacing (appears as Left bundle branch block)
- Brugada syndrome
- Takotsubo cardiomyopathy
- AVR ST elevation
- Other thoracic
- Metabolic
- Drugs of abuse (eg, cocaine, crack, meth)
- Hyperkalemia (only leads V1 and V2)
- Hypothermia ("Osborn J waves")
- Medications
Evaluation
Workup
- EKG
- Usually presents as an Anterior MI with ST changes in anterior Precordial leads (V1-V3)
- Basic labs, including troponin
- Echocardiography
Diagnosis
- EKG usually shows an Anterior MI with ST changes in anterior Precordial leads (V1-V3)
- Troponin may be elevated
- Definitive diagnosis made at time of coronary angiography
Management
- Aspirin, β-blocker, and 1 year of clopidogrel[1]
- Cardiology consultation
- PCI can be challenging given vessel wall fragility
Disposition
- Admit
See Also
External Links
References
- ↑ Saw J, Aymong E, Sedlak T, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv 2014; 7:645.