Spontaneous coronary artery dissection differential diagnosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(29 intermediate revisions by one other user not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Spontaneous coronary artery dissection}}
{{Spontaneous coronary artery dissection}}
{{CMG}}; {{AE}}{{AKK}}
{{CMG}}; {{AE}} {{Sara.Zand}} {{AKK}}


{{SK}} SCAD
{{SK}} SCAD
Line 10: Line 10:


==Differential Diagnosis==
==Differential Diagnosis==
Albeit an infrequent condition, [[spontaneous coronary artery dissection]] ([[SCAD]]) should be included in the differential diagnosis of [[acute coronary syndrome|acute coronary syndrome]], particularly among young [[women]] with [[risk factors]] such as [[vasculopathy]], [[pregnancy]], [[connective tissue disorder]], [[systemic inflammation]], [[exercise|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|intravascular ultrasound]] ([[IVUS]]) and [[optical coherence tomography|optical coherence tomography]] ([[OCT]]) may be required for establishing a definitive diagnosis.
===Differentiating [[spontaneous coronary artery dissection]] from other diseases ===
<ref name="PauloSandoval2013">{{cite journal|last1=Paulo|first1=Manuel|last2=Sandoval|first2=Jorge|last3=Lennie|first3=Vera|last4=Dutary|first4=Jaime|last5=Medina|first5=Miguel|last6=Gonzalo|first6=Nieves|last7=Jimenez-Quevedo|first7=Pilar|last8=Escaned|first8=Javier|last9=Bañuelos|first9=Camino|last10=Hernandez|first10=Rosana|last11=Macaya|first11=Carlos|last12=Alfonso|first12=Fernando|title=Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection|journal=JACC: Cardiovascular Imaging|volume=6|issue=7|year=2013|pages=830–832|issn=1936878X|doi=10.1016/j.jcmg.2013.02.010}}</ref><ref name="AdlamAlfonso2018">{{cite journal|last1=Adlam|first1=David|last2=Alfonso|first2=Fernando|last3=Maas|first3=Angela|last4=Vrints|first4=Christiaan|last5=al-Hussaini|first5=Abtehale|last6=Bueno|first6=Hector|last7=Capranzano|first7=Piera|last8=Gevaert|first8=Sofie|last9=Hoole|first9=Stephen P|last10=Johnson|first10=Tom|last11=Lettieri|first11=Corrado|last12=Maeder|first12=Micha T|last13=Motreff|first13=Pascal|last14=Ong|first14=Peter|last15=Persu|first15=Alexandre|last16=Rickli|first16=Hans|last17=Schiele|first17=Francois|last18=Sheppard|first18=Mary N|last19=Swahn|first19=Eva|title=European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection|journal=European Heart Journal|volume=39|issue=36|year=2018|pages=3353–3368|issn=0195-668X|doi=10.1093/eurheartj/ehy080}}</ref><ref>{{cite journal|doi=10.1136/2Fhrt.53.4.363}}</ref><ref name="Davies1996">{{cite journal|last1=Davies|first1=Michael J.|title=The contribution of thrombosis to the clinical expression of coronary atherosclerosis|journal=Thrombosis Research|volume=82|issue=1|year=1996|pages=1–32|issn=00493848|doi=10.1016/0049-3848(96)00035-7}}</ref><ref name="YASUEMIZUNO2019">{{cite journal|last1=YASUE|first1=Hirofumi|last2=MIZUNO|first2=Yuji|last3=HARADA|first3=Eisaku|title=Coronary artery spasm — Clinical features, pathogenesis and treatment —|journal=Proceedings of the Japan Academy, Series B|volume=95|issue=2|year=2019|pages=53–66|issn=0386-2208|doi=10.2183/pjab.95.005}}</ref><ref name="ShepherdVanhoutte1985">{{cite journal|last1=Shepherd|first1=John T.|last2=Vanhoutte|first2=Paul M.|title=Spasm of the Coronary Arteries: Causes and Consequences (the Scientist's Viewpoint)|journal=Mayo Clinic Proceedings|volume=60|issue=1|year=1985|pages=33–46|issn=00256196|doi=10.1016/S0025-6196(12)65280-X}}</ref><ref name="KoyamaYamagishi1995">{{cite journal|last1=Koyama|first1=Jun|last2=Yamagishi|first2=Masakazu|last3=Tamai|first3=Jun|last4=Kawano|first4=Shigeo|last5=Daikoku|first5=Satoshi|last6=Miyatake|first6=Kunio|title=Comparison of vessel wall morphologic appearance a sites of focal and diffuse coronary vasospasm by intravascular ultrasound|journal=American Heart Journal|volume=130|issue=3|year=1995|pages=440–445|issn=00028703|doi=10.1016/0002-8703(95)90349-6}}</ref><ref name="MiyaoKugiyama2000">{{cite journal|last1=Miyao|first1=Yuji|last2=Kugiyama|first2=Kiyotaka|last3=Kawano|first3=Hiroaki|last4=Motoyama|first4=Takeshi|last5=Ogawa|first5=Hisao|last6=Yoshimura|first6=Michihiro|last7=Sakamoto|first7=Tomohiro|last8=Yasue|first8=Hirofumi|title=Diffuse intimal thickening of coronary arteries in patients with coronary spastic angina|journal=Journal of the American College of Cardiology|volume=36|issue=2|year=2000|pages=432–437|issn=07351097|doi=10.1016/S0735-1097(00)00729-4}}</ref><ref name="TweetGulati2016">{{cite journal|last1=Tweet|first1=Marysia S.|last2=Gulati|first2=Rajiv|last3=Williamson|first3=Eric E.|last4=Vrtiska|first4=Terri J.|last5=Hayes|first5=Sharonne N.|title=Multimodality Imaging for Spontaneous Coronary Artery Dissection in Women|journal=JACC: Cardiovascular Imaging|volume=9|issue=4|year=2016|pages=436–450|issn=1936878X|doi=10.1016/j.jcmg.2016.01.009}}</ref><ref name="BulluckDharmakumar2018">{{cite journal|last1=Bulluck|first1=Heerajnarain|last2=Dharmakumar|first2=Rohan|last3=Arai|first3=Andrew E.|last4=Berry|first4=Colin|last5=Hausenloy|first5=Derek J.|title=Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction|journal=Circulation|volume=137|issue=18|year=2018|pages=1949–1964|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.030693}}</ref><ref>{{cite journal|doi=10.1016/j.carreu.2020.09.032}}</ref>


{{details|acute coronary syndromes#Differential Diagnosis|differential diagnosis of acute coronary syndrome}}


Albeit an infrequent condition, spontaneous coronary artery dissection (SCAD) should be included in the differential diagnosis of [[acute coronary syndrome|acute coronary syndrome]], particularly among young women with risk factors such as [[vasculopathy]], [[pregnancy]], [[connective tissue disorder]], [[systemic inflammation]], [[exercise|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|intravascular ultrasound (IVUS)]] and [[optical coherence tomography|optical coherence tomography (OCT)]] may be required for establishing a definitive diagnosis.


==Differentiating [Disease name] from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].


OR


[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].


OR


As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].


===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===<ref name="PauloSandoval2013">{{cite journal|last1=Paulo|first1=Manuel|last2=Sandoval|first2=Jorge|last3=Lennie|first3=Vera|last4=Dutary|first4=Jaime|last5=Medina|first5=Miguel|last6=Gonzalo|first6=Nieves|last7=Jimenez-Quevedo|first7=Pilar|last8=Escaned|first8=Javier|last9=Bañuelos|first9=Camino|last10=Hernandez|first10=Rosana|last11=Macaya|first11=Carlos|last12=Alfonso|first12=Fernando|title=Combined Use of OCT and IVUS in Spontaneous Coronary Artery Dissection|journal=JACC: Cardiovascular Imaging|volume=6|issue=7|year=2013|pages=830–832|issn=1936878X|doi=10.1016/j.jcmg.2013.02.010}}</ref>




On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
Line 58: Line 57:
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 3
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Thrombotic [[STEMI]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[STEMI]]
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] radiated to [[arms]], [[neck]], [[back]], [[jaw]]
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] with radiation to [[arms]], [[neck]], [[back]], [[jaw]]
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faintness]]
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faint]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]]
| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[bradycardia]]
| style="background: #F5F5F5; padding: 5px;" |[[Hypertension]], [[hypotension]], [[syncope]]
| style="background: #F5F5F5; padding: 5px;" |[[Hypertension]], [[hypotension]], [[syncope]]
| style="background: #F5F5F5; padding: 5px;" |[[S4]] [[heart sound]], [[rale]], [[holosystolic murmur]] in apex
| style="background: #F5F5F5; padding: 5px;" |[[S4]] [[heart sound]], [[rale]], [[holosystolic murmur]] in apex
Line 68: Line 67:
| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
| style="background: #F5F5F5; padding: 5px;" |↑[[C-reactive protein]], [[BNP]]
| style="background: #F5F5F5; padding: 5px;" |↑[[C-reactive protein]], [[BNP]]
| style="background: #F5F5F5; padding: 5px;" |[[Cardiac]] [[magnetic resonance imaging]] ([[CMR]]): [[myocardial edema]], [[microvascular obstruction]], [[intramyocardial hemorrhage]], [[MI]] size
| style="background: #F5F5F5; padding: 5px;" |Intravascular imaging during [[PCI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Occlusive [[coronary]] [[thrombus]] formation superimposed on a ruptured or eroded [[atherosclerotic]] plaque
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Coagulation necrosis]], [[granulation tissue]], [[collagen deposition]], [[scar formation]]
| style="background: #F5F5F5; padding: 5px;" |[[Coronary angiography]]
| style="background: #F5F5F5; padding: 5px;" |[[Coronary angiography]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spontaneous coronary artery dissection]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spontaneous coronary artery dissection]]
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] radiated to [[arms]], [[neck]], [[back]], [[jaw]]
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] with radiation to [[arms]], [[neck]], [[back]], [[jaw]]
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faintness]]
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faintness]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]]
| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[bradycardia]]
| style="background: #F5F5F5; padding: 5px;" |[[Hypertension]], [[hypotension]], [[syncope]]
| style="background: #F5F5F5; padding: 5px;" |[[Hypertension]], [[hypotension]], [[syncope]]
| style="background: #F5F5F5; padding: 5px;" |[[S4]] [[heart sound]], [[rale]], [[holosystolic murmur]] in apex
| style="background: #F5F5F5; padding: 5px;" | [[rale]], [[holosystolic murmur]] in apex
| style="background: #F5F5F5; padding: 5px;" |↑[[Troponin]] I, T
| style="background: #F5F5F5; padding: 5px;" |↑[[Troponin]] I, T
| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Coronary angiography]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[intravascular ultrasound]] ([[IVUS]]), [[optical coherence tomography]] ([[OCT]])
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | [[Coronary CT angiography]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''[[Intimal]] [[tear]]''', [[medial dissection]], [[hemorrhage formation]], [[false lumen]] formation.'''[[Hematoma ]]''' formation in [[media]], separation of two arterial layers, formation of false [[lumen]], dissection of the true [[lumen]]
| style="background: #F5F5F5; padding: 5px;" |[[Intracoronary imaging]] such as [[intravascular ultrasound]] ([[IVUS]]), [[optical coherence tomography]] ([[OCT]])
| style="background: #F5F5F5; padding: 5px;" |[[Intracoronary imaging]] such as [[intravascular ultrasound]] ([[IVUS]]), [[optical coherence tomography]] ([[OCT]])
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Mimicing [[ECG]] changes of  [[STMI]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Coronary vasospasm]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Chest discomfort]] with radiation to [[arms]], [[neck]], [[back]], [[jaw]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Shortness of breath]], [[dizziness]], [[faintness]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Nausea]], [[vomiting]], [[sweating]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[bradycardia]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Hypertension]], [[hypotension]], [[syncope]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Rale]], [[holosystolic murmur]] in apex
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |↑[[Troponin]] I, T
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |↑[[Creatin kinase]] MB ([[CKMB]])
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!symptom1
! colspan="1" rowspan="1" |symptom2
!symptom3
!Physical exam 1
! colspan="1" rowspan="1" |Physical exam 2
!Physical exam 3
!Lab 1
!Lab 2
!Lab 3
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | [[IVUS]] findings: negative [[remodeling]], diffuse [[intima]], thick media, and wrinkles in the internal elastic membrane even in the absence of a significant [[coronary stenosis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | [[Morphologic]] changes in the [[artery]] at the site of the [[spasm]], [[endothelium]] damaged, [[Platelets]] aggregation at this site  releasing [[vasoactive]] substances, [[thrombin]] formation
| style="background: #F5F5F5; padding: 5px;" |[[Coronary angiography]] and [[spasm]] provocation test
| style="background: #F5F5F5; padding: 5px;" |occurring most often from [[midnight]] to early [[morning]], Mimicing [[ECG]] changes of  [[STMI]]
|}
|}


Latest revision as of 19:41, 10 April 2021

Spontaneous Coronary Artery Dissection Microchapters

Home

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: Sara Zand, M.D.[2] Arzu Kalayci, M.D. [3]

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 spontaneous coronary artery dissection from other diseases

[1][2][3][4][5][6][7][8][9][10][11]







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 with radiation to arms, neck, back, jaw Shortness of breath, dizziness, faint 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 Cardiac magnetic resonance imaging (CMR): myocardial edema, microvascular obstruction, intramyocardial hemorrhage, MI size Intravascular imaging during PCI Occlusive coronary thrombus formation superimposed on a ruptured or eroded atherosclerotic plaque Coronary angiography
Spontaneous coronary artery dissection Chest discomfort with radiation 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 Intimal tear, medial dissection, hemorrhage formation, false lumen formation.Hematoma formation in media, separation of two arterial layers, formation of false lumen, dissection of the true lumen Intracoronary imaging such as intravascular ultrasound (IVUS), optical coherence tomography (OCT) Mimicing ECG changes of STMI
Coronary vasospasm Chest discomfort with radiation 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

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ . doi:10.1136/2Fhrt.53.4.363. Missing or empty |title= (help)
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ Koyama, Jun; Yamagishi, Masakazu; Tamai, Jun; Kawano, Shigeo; Daikoku, Satoshi; Miyatake, Kunio (1995). "Comparison of vessel wall morphologic appearance a sites of focal and diffuse coronary vasospasm by intravascular ultrasound". American Heart Journal. 130 (3): 440–445. doi:10.1016/0002-8703(95)90349-6. ISSN 0002-8703.
  8. ↑ Miyao, Yuji; Kugiyama, Kiyotaka; Kawano, Hiroaki; Motoyama, Takeshi; Ogawa, Hisao; Yoshimura, Michihiro; Sakamoto, Tomohiro; Yasue, Hirofumi (2000). "Diffuse intimal thickening of coronary arteries in patients with coronary spastic angina". Journal of the American College of Cardiology. 36 (2): 432–437. doi:10.1016/S0735-1097(00)00729-4. ISSN 0735-1097.
  9. ↑ Tweet, Marysia S.; Gulati, Rajiv; Williamson, Eric E.; Vrtiska, Terri J.; Hayes, Sharonne N. (2016). "Multimodality Imaging for Spontaneous Coronary Artery Dissection in Women". JACC: Cardiovascular Imaging. 9 (4): 436–450. doi:10.1016/j.jcmg.2016.01.009. ISSN 1936-878X.
  10. ↑ Bulluck, Heerajnarain; Dharmakumar, Rohan; Arai, Andrew E.; Berry, Colin; Hausenloy, Derek J. (2018). "Cardiovascular Magnetic Resonance in Acute ST-Segment–Elevation Myocardial Infarction". Circulation. 137 (18): 1949–1964. doi:10.1161/CIRCULATIONAHA.117.030693. ISSN 0009-7322.
  11. ↑ . doi:10.1016/j.carreu.2020.09.032. Missing or empty |title= (help)
Retrieved from "https://www.wikidoc.org/index.php?title=Spontaneous_coronary_artery_dissection_differential_diagnosis&oldid=1696767"