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| __NOTOC__
| | While Type 1 SCAD has a pathognomonic appearance on angiography, Type 2 may be and Type 3 typically is indistinguishable from [[atherosclerosis]]. Risk factors and patient history may help determine diagnosis. Intracoronary imaging provides the most objective tool in differentiating between SCAD and [[atheroma]].<ref name="pmid25774346">{{cite journal| author=Yip A, Saw J| title=Spontaneous coronary artery dissection-A review. | journal=Cardiovasc Diagn Ther | year= 2015 | volume= 5 | issue= 1 | pages= 37-48 | pmid=25774346 | doi=10.3978/j.issn.2223-3652.2015.01.08 | pmc=4329168 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25774346 }} </ref><ref name="BuccheriPiraino2016">{{cite journal|last1=Buccheri|first1=Dario|last2=Piraino|first2=Davide|last3=Latini|first3=Roberto A.|last4=Andolina|first4=Giuseppe|last5=Cortese|first5=Bernardo|title=Spontaneous coronary artery dissections: A call for action for an underestimated entity|journal=International Journal of Cardiology|volume=214|year=2016|pages=333–335|issn=01675273|doi=10.1016/j.ijcard.2016.03.131}}</ref> |
| {{Spontaneous coronary artery dissection}}
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| {| class="wikitable" style="font-size: 85%;"
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| ! style="background: #4479BA; text-align: center; width: 150px;" |{{fontcolor|#FFF|Potential factor}}
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| ! style="background: #4479BA; text-align: center; width: 850px;" colspan=2 | {{fontcolor|#FFF|Condition}}
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| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Predisposing causes'''
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| | style="background: #F5F5F5; padding: 5px;" colspan="2;"|
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| * Fibromuscular dysplasia
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| * Pregnancy-related: antepartum, early post-partum, late post- partum, very late post-partum
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| * Recurrent pregnancies: multiparity or multigravida
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| * Connective tissue disorder: Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome type 4, cystic medial necrosis, alpha-1 antitrypsin deficiency, polycystic kidney disease
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| * Systemic inflammatory disease: systemic lupus erythematosus, Crohn’s disease, ulcerative colitis, polyarteritis nodosa, sarcoidosis, Churg-Strauss syndrome, Wegener's granulomatosis, rheumatoid arthritis, Kawasaki disease, giant cell arteritis, celiac disease
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| * Hormonal therapy: oral contraceptive, estrogen, progesterone, beta-HCG, testosterone, corticosteroids
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| * Coronary artery spasm
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| * Idiopathic
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| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" | '''Precipitating stressors'''
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| | style="background: #F5F5F5; padding: 5px;" colspan="2;"|
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| * Intense exercises including isometric or aerobic activities
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| * Intense emotional stress
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| * Labor and delivery
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| * Intense Valsava-type activities: retching, vomiting, bowel movement, coughing
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| * Recreational drugs: cocaine, amphetamines, metamphetamines
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| * Intense hormonal therapy: beta-HCG injections, corticosteroids injections
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| |}
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| <!---
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| <div style="font-size: 80%;" align="center">
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| <span style="font-size: 1.5em; font-weight: bold;">Algorithm for the Angiographic Diagnosis and Confirmation of Spontaneous Coronary Artery Dissection</span><ref name="pmid24227590">{{cite journal| author=Saw J| title=Coronary angiogram classification of spontaneous coronary artery dissection. | journal=Catheter Cardiovasc Interv | year= 2014 | volume= 84 | issue= 7 | pages= 1115-22 | pmid=24227590 | doi=10.1002/ccd.25293 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24227590}}</ref><BR><BR>
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| {{Familytree/start}}
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| {{Familytree | | | | | A01 | | | | | | | | |
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| A01=<div style="text-align: left; font-weight: bold; padding: 5px;">
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| <div class="mw-customtoggle-x1" style="cursor: pointer;>
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| Presence of features that raise suspicion for SCAD?<BR><span style="color: #0645AD;">(click for details)</span>
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| </div>
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| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x1" style="font-size: 10px;">
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| ----
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| ❑ [[Myocardial infarction]] in young women (age ≤50)
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| ❑ Absence of traditional [[Cardiovascular disease#Risk factors|cardiovascular risk factors]]
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| ❑ Little or no evidence of [[coronary atherosclerosis]]
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| ❑ [[Peripartum|Peripartum state]]
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| ❑ History of [[fibromuscular dysplasia]]
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| ❑ History of [[connective tissue disorder]] or [[systemic inflammation]]
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| ❑ [[Marfan's syndrome]]
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| ❑ [[Ehlers-Danlos syndrome|Type 4 Ehlers-Danlos syndrome]]
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| ❑ [[Loeys-Dietz syndrome]]
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| ❑ [[Cystic medial necrosis]]
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| ❑ [[Systemic lupus erythematosus]]
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| ❑ [[Crohn's disease]]
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| ❑ [[Ulcerative colitis]]
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| ❑ [[Polyarteritis nodosa]]
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| ❑ [[Sarcoidosis]]
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| ❑ [[Churg-Strauss syndrome]]
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| ❑ [[Wegener's granulomatosis]]
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| ❑ [[Rheumatoid arthritis]]
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| ❑ [[Giant cell arteritis]]
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| ----
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| </div>
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| </div>}}
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| {{Familytree | | | | | |!| | | | | | | | | | }} | |
| {{Familytree | | | | | B01 | | | | | | | | |
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| B01=<div style="text-align: left; font-weight: bold; padding: 5px;">
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| Perform early coronary angiography
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| </div>}}
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| {{Familytree | | | | | |!| | | | | | | | | | }}
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| {{Familytree | | | | | C01 | | | | | | | | |
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| C01=<div style="text-align: left; font-weight: bold; padding: 5px;">
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| <div class="mw-customtoggle-x2" style="cursor: pointer;>
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| Presence of type 1 SCAD lesion characteristics?<BR><span style="color: #0645AD;">(click for details)</span>
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| </div>
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| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x2" style="font-size: 10px;">
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| ----
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| ❑ Contrast staining of arterial wall
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| ❑ Multiple radiolucent lumens
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| ❑ Contrast hang-up or slow clearing from the lumen
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| ----
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| </div>
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| </div>}}
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| {{Familytree | |,|-|-|-|^|-|-|-|.| | | | | | }}
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| {{Familytree | D01 | | | | | | D02 | | | | |
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| D01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
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| D02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>
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| }}
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| {{Familytree | |!| | | | | | | |!| | | | | | }}
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| {{Familytree | E01 | | | | | | E02 | | | | |
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| E01=<div style="text-align: left; font-weight: bold; padding: 5px;">Type 1 SCAD most likely</div>|
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| E02=<div style="text-align: left; font-weight: bold; padding: 5px;">
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| <div class="mw-customtoggle-x3" style="cursor: pointer;>
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| Presence of type 2 SCAD lesion characteristics?<BR><span style="color: #0645AD;">(click for details)</span>
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| </div>
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| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x3" style="font-size: 10px;">
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| ----
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| ❑ Diffuse lesion (typically >20–30 mm)
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|
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| ❑ Smooth luminal narrowing with varying severity
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| ❑ Involvement of mid to distal segments
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| ----
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| </div>
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| </div>
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| }}
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| {{Familytree | | | | | |,|-|-|-|^|-|-|-|.| | }}
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| {{Familytree | | | | | F01 | | | | | | F02 |
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| F01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
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| F02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>
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| }}
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| {{Familytree | | | | | |!| | | | | | | |!| | }}
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| {{Familytree | | | | | G01 | | | | | | G02 |
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| G01=<div style="text-align: left; font-weight: bold; padding: 5px;">Stenosis relieved by intracoronary nitroglycerin?</div>|
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| G02=<div style="text-align: left; font-weight: bold; padding: 5px;">
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| <div class="mw-customtoggle-x4" style="cursor: pointer;>
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| Look for type 3 SCAD lesion characteristics<BR><span style="color: #0645AD;">(click for details)</span>
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| </div>
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| <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x4" style="font-size: 10px;">
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| ----
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| ❑ Focal or tubular stenosis (typically <20 mm)
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|
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| ❑ Mimics atherosclerosis
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| ❑ Additional features
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| ❑ No atherosclerosis in other arteries
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| ❑ Long lesions (11–20 mm)
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| ❑ Hazy stenosis
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| ❑ Linear stenosis
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| ----
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| </div>
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| </div>
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| }}
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| {{Familytree | |,|-|-|-|^|-|-|-|.| | | |!| | }}
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| {{Familytree | H01 | | | | | | H02 | | H03 |
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| H01=<div style="text-align: center; font-weight: bold; padding: 5px;">YES</div>|
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| H02=<div style="text-align: center; font-weight: bold; padding: 5px;">NO</div>|
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| H03=<div style="text-align: left; font-weight: bold; padding: 5px;">
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| Type 3 SCAD most likely
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| ❑ Consider OCT or IVUS for definitive diagnosis
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| ❑ Reassess with angiography in 4 to 6 weeks
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| </div>
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| }}
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| {{Familytree | |!| | | | | | | |!| | | | | | }}
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| {{Familytree | I01 | | | | | | I02 | | | | |
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| I01=<div style="text-align: left; font-weight: bold; padding: 5px;">R/O coronary spasm or other conditions</div>|
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| I02=<div style="text-align: left; font-weight: bold; padding: 5px;">
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| Type 2 SCAD most likely
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| ❑ Consider OCT or IVUS for definitive diagnosis
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| ❑ Reassess with angiography in 4 to 6 weeks
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| </div>}}
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| {{Family tree/end}}
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| </div> | |
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| ==References==
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| {{reflist|2}}
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