Spontaneous coronary artery dissection screening

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Spontaneous Coronary Artery Dissection Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Spontaneous coronary artery dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Approach

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Angiography

CT

MRI

Echocardiography

Other Imaging Findings

Other Diagnostic Studies

Treatment

Treatment Approach

Medical Therapy

Percutaneous Coronary Intervention

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Type 1

Type 2A

Type 2B

Type 3

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Synonyms and keywords: SCAD

Overview

SCAD usually is the result of an underlying vascular or connective tissue disorders. In order to provide the best care to patients with SCAD, the scientific statement from the American Heart Association (AHA) recommends a detailed review of systems and personal and family history of SCAD-associated symptoms and conditions. In addition, the AHA statement recommends a complete vascular exam. Routine clinical or genetic screening of asymptomatic relatives of patients with SCAD is not recommended. However, genetic screening is recommended in first-degree family members of patients with SCAD in whom a monogenic vascular disease has been identified.

Screening

SCAD usually is the result of an underlying vascular or connective tissue disorders. In order to provide the best care to patients with SCAD, the scientific statement from the American Heart Association (AHA) recommends a detailed review of systems and personal and family history of SCAD-associated symptoms and conditions. [1]
In addition, the AHA statement recommends a complete vascular exam with palpation and auscultation of the following arteries:

Screening Questions

The AHA statement recommends a list of questions to rule out SCAD-associated vasculopathy and connective tissue disorders: [1]

 
 
 
 
Screening Questions:

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Personal history of the following conditions:

❑ Early-onset hypertension
Stroke or transient ischemic attack
❑ Pulsatile tinnitus
Migraine headaches
Renal infarction
Subarachnoid hemorrhage
Aneurysm (aortic, peripheral, brain)
Dissection (aortic, peripheral)
❑ Rupture of hollow organs (intestinal, bladder, uterine)
Pneumothorax
❑ Tendon or muscle rupture
Joint dislocation
❑ Talipes equinovarus (clubfoot)
Umbilical or inguinal hernia
Scoliosis or pectus deformity
Pregnancy complications (cervical incompetence, hemorrhage, uterine prolapse, hypertension)
❑ Poor wound healing
Ectopia lentis
Myopia
❑ Detached retina, early glaucoma, or early cataracts
❑ Tall stature
❑ Abnormality of cardiac valve (bicuspid aortic valve, mitral valve prolapse)
Systemic inflammatory disease


Family history of the following conditions:

Dissection (coronary, aortic, peripheral)
❑ Inherited arteriopathy or connective tissue disorder (eg, vascular Ehlers-Danlos syndrome, Marfan syndrome, Loeys-Dietz syndrome)
Fibromuscular dysplasia
Aneurysm (aortic, peripheral, brain)
❑ Early stroke, early myocardial infarction, sudden cardiac death


Review of systems (history of any of the following symptoms)

Headaches
❑ Pulsatile tinnitus
❑ Postprandial abdominal pain
Flank pain
Claudication
Easy bruising
Joint hypermobility or laxity
 
 
 
 
The above table adopted from AHA scientific statement [1]

Genetic Screening of Family Members

References

  1. 1.0 1.1 1.2 1.3 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. 137 (19). doi:10.1161/CIR.0000000000000564. ISSN 0009-7322.