Spontaneous coronary artery dissection: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Spontaneous coronary artery dissection}} | {{Spontaneous coronary artery dissection}} | ||
{{CMG}}; {{AE}} {{NRM}} , {{AKK}} | {{CMG}}; {{AE}} {{NRM}}, {{AKK}} | ||
{{SK}} SCAD | {{SK}} SCAD | ||
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==Treatment== | ==Treatment== | ||
[[Spontaneous coronary artery dissection medical therapy|Medical Therapy]] | [[Spontaneous coronary artery dissection percutaneous coronary intervention|Percutaneous Coronary Intervention]] | [[Spontaneous coronary artery dissection surgery|Surgery]] | [[Spontaneous coronary artery dissection primary prevention|Primary Prevention]] | [[Spontaneous coronary artery dissection secondary prevention|Secondary Prevention]] | [[Spontaneous coronary artery dissection cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Spontaneous coronary artery dissection future or investigational therapies|Future or Investigational Therapies]] | [[Spontaneous coronary artery dissection medical therapy|Medical Therapy]] | [[Spontaneous coronary artery dissection percutaneous coronary intervention|Percutaneous Coronary Intervention]] | [[Spontaneous coronary artery dissection surgery|Surgery]] | [[Spontaneous coronary artery dissection primary prevention|Primary Prevention]] | [[Spontaneous coronary artery dissection secondary prevention|Secondary Prevention]] | [[Spontaneous coronary artery dissection cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Spontaneous coronary artery dissection future or investigational therapies|Future or Investigational Therapies]] | ||
==Algorithm== | |||
{{Familytree/start}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | |||
{{Familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | A01=<div style="text-align: center; background: #FFF0F5; font-weight: bold; padding: 10px;">'''Spontaneous Coronary Artery Dissection (SCAD)'''</div>}} | |||
{{Familytree | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | | | | | | | | | | | | | | | | | | | | | }} | |||
{{Familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | B01 | | | | | | | | | | B02 | | | | | | | | | | | | | | | | | | | | | | | | | B01= <div style="text-align: center; background: #FFF0F5; font-weight: bold; padding: 10px;">'''Stable,no high-risk feature'''</div>|B02= <div style="text-align: center; background: #FFF0F5; font-weight: bold; padding: 10px;"> '''High-risk feature present'''</div>}} | |||
{{familytree | | | |!| | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | | | |,|-|-|-|^|-|-|-|v|-|-|-|v|-|-|-|.| | | | | | | | | | | | | | }} | |||
{{familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | |!| | | | | | | C01 | | | | | | C02 | | C03 | | C04 | | | | | | | | | | | | | C01=<div style="text-align: center; background: #FFF0F5; font-weight: bold; padding: 30px;">Left main dissection</div>|C02=<div style="text-align: center; background: #FFF0F5; font-weight: bold; padding: 30px;">Ongoing/recurrent ischemia</div>|C03=<div style="text-align: center; background: #FFF0F5; font-weight: bold; padding: 20px;">Ventricular tachycardia or fibrillation</div>|C04=<div style="text-align: center; background: #FFF0F5; font-weight: bold; padding: 30px;">Cardiogenic shock</div>}} | |||
{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |`|-|v|-|'| | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | | | |!| | | | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | | | Z01 | | | | | | | | | | | | | | | Z01=Hemodynamically unstable?}} | |||
{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | | | |!| | | | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |,|-|^|-|.| | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | D01 | | D02 | | | | | | | | | | | | | D01=No | D02=Yes }} | |||
{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | |!| | | | | | | | | | | | | | }} | |||
{{familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | E01 | | | | | | | | | | | | | E01=<div style="text-align: center; background: #87CEFA; font-weight: bold; padding: 30px;">Consider: Intra-aortic balloon pump, Extra corporeal membrane oxygenation, Left ventricular assist device, Implantable cardioverter defibrillator</div>}} | |||
{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | |!| | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | |!| | | |!| | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | |,|-|^|-|.| | | | | |`|-|v|-|'| | | |!| | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | |!| | | |!| | | | | | | |!| | | | | |!| | | | | | | | | | | | | | }} | |||
{{familytree |boxstyle=width: 1200px; font-size: 90%; padding: 0px;| | | |!| | | | | F01 | | F02 | | | | | | F03 |-|-|-|-|'| | | | | | | | | | | | | | F01= <div style="text-align: center; background: #FFF0F5; font-weight: bold; padding: 30px;">Isolated Left Main</div>|F02= <div style="text-align: center; background: #FFF0F5; font-weight: bold; padding: 10px;">Involving Left Anterior Descending (LAD +/or circumflex</div>| F03= <div style="text-align: center; background: #FFF0F5; font-weight: bold; padding: 30px;">Is percutaneous coronary intervention (PCI) feasible?</div>}} | |||
{{familytree | | | |!| | | | | |!| | | |!| | | | | | | |!| | | | | | | | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | |!| | | |!| | | | | |,|-|^|-|-|-|.| | | | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | |!| | | |!| | | | | G01 | | | | G02 | | | | | | | | | | | | | | | G01=No | G02=Yes }} | |||
{{familytree | | | |!| | | | | |!| | | |!| | | | | |!| | | | | |!| | | | | | | | | | | | | | | | }} | |||
{{familytree | | | |!| | | | | |!| | | |!| | | | | H01 | | | | |!| | | | | | | | | | | | | | | | H01 = Ostial LAD or ≥ 2 proximal SCAD?}} | |||
{{familytree | | | |!| | | | | |!| | | |!| | | |,|-|^|-|.| | | |!| | | | | | | | | | | | | | | | }} | |||
{{familytree | | | I02 | | | | I03 | | |`|-|-| I01 | | I02 | | I03 | | | | | | | | | | | | | | | I01=Coronary artery bypassing | I02=Conservative therapy | I03=PCI}} | |||
{{familytree | | | |`|-|-|-|-|-|^|-|-|-|v|-|-|-|^|-|-|-|^|-|-|-|'| | | | | | | | | | | | | | | | }} | |||
{{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | |||
{{familytree | | | | | | | | | | | | | J01 | | | | | | | | | | | | | | | | | | | | | | | | | | | J01='''Adjunctive medical therapy''' <BR> Aspirin and beta-blocker (± clopidogrel, ACEI/ARB, statin)}} | |||
{{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | }} | |||
{{familytree | | | | | | | | | | | | | K01 | | | | | | | | | | | | | | | | | | | | | | | | | | | K01=Monitor in-hospital for 3 to 5 days}} | |||
{{Family tree/end}} | |||
Revision as of 20:33, 27 November 2017
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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., Arzu Kalayci, M.D. [2]
Synonyms and keywords: SCAD
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Any Disease from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Angiography | CT | MRI | Echocardiography | Other Imaging Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Percutaneous Coronary Intervention | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Algorithm
Spontaneous Coronary Artery Dissection (SCAD) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Stable,no high-risk feature | High-risk feature present | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Left main dissection | Ongoing/recurrent ischemia | Ventricular tachycardia or fibrillation | Cardiogenic shock | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hemodynamically unstable? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Consider: Intra-aortic balloon pump, Extra corporeal membrane oxygenation, Left ventricular assist device, Implantable cardioverter defibrillator | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Isolated Left Main | Involving Left Anterior Descending (LAD +/or circumflex | Is percutaneous coronary intervention (PCI) feasible? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ostial LAD or ≥ 2 proximal SCAD? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Conservative therapy | PCI | Coronary artery bypassing | Conservative therapy | PCI | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Adjunctive medical therapy Aspirin and beta-blocker (± clopidogrel, ACEI/ARB, statin) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Monitor in-hospital for 3 to 5 days | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||