Spontaneous coronary artery dissection differential diagnosis

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

Synonyms and keywords: SCAD

Differential Diagnosis

Further information: acute coronary syndromes and 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, particularly among young women with risk factors such as vasculopathy, pregnancy, connective tissue disorder, systemic inflammation, strenuous exercise, emotional stress, or recreational drug use. Although intracoronary imaging such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) may be required for establishing a definitive diagnosis of SCAD, demographic and angiographic characteristics may be useful in differentiating SCAD from other causes of myocardial ischemia.

Demographic characteristics that raise the index of suspicion for SCAD 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
• History of connective tissue disorder or systemic inflammatory disorder:

• Marfan's syndrome
• Type 4 Ehlers-Danlos syndrome
• Loeys-Dietz syndrome
• Cystic medial necrosis
• Systemic lupus erythematosus
• Crohn's disease
• Ulcerative colitis
• Polyarteritis nodosa
• Sarcoidosis
• Churg-Strauss syndrome
• Wegener's granulomatosis
• Rheumatoid arthritis
• Giant cell arteritis

Angiographic characteristics that favor the diagnosis of SCAD include: