Spontaneous coronary artery dissection medical therapy: Difference between revisions
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There are no specific guidelines regarding the optimal management of spontaneous coronary artery dissection. Based on the clinical and angiographic scenario, treatment options include conservative medical regimens similar to that for [[acute coronary syndrome]], [[percutaneous coronary intervention]], and/or [[coronary artery bypass surgery]]. In the majority of cases, SCAD may be managed successfully with medical treatment alone in the absence of ongoing [[myocardial ischemia]] or [[hemodynamic instability]].<ref name="pmid25294399">{{cite journal| author=Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D et al.| title=Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 5 | pages= 645-55 | pmid=25294399 | doi=10.1161/CIRCINTERVENTIONS.114.001760 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25294399 }} </ref><ref name="pmid22800851">{{cite journal| author=Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ et al.| title=Clinical features, management, and prognosis of spontaneous coronary artery dissection. | journal=Circulation | year= 2012 | volume= 126 | issue= 5 | pages= 579-88 | pmid=22800851 | doi=10.1161/CIRCULATIONAHA.112.105718 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22800851 }} </ref> Initial conservative management typically includes antithrombotic therapy with [[heparin]], [[aspirin]], [[clopidogrel]] and [[glycoprotein IIb/IIIa inhibitors]], and antiischemic therapy with [[beta blockers]] and [[nitrate]]s. However, the use of antithrombotic therapy may increase the risk of bleeding in the false lumen causing an expansion of the intramural hematoma, resulting in a decreased flow through the true lumen.<ref name="Vrints-2010">{{Cite journal | last1 = Vrints | first1 = CJ. | title = Spontaneous coronary artery dissection. | journal = Heart | volume = 96 | issue = 10 | pages = 801-8 | year = 2010 | doi = 10.1136/hrt.2008.162073 | PMID = 20448134 }}</ref> [[Fibrinolytic]]s should be avoided. [[Calcium channel blocker]]s may offer relief in [[coronary artery spasm]]. | There are no specific guidelines regarding the optimal management of spontaneous coronary artery dissection. Based on the clinical and angiographic scenario, treatment options include conservative medical regimens similar to that for [[acute coronary syndrome]], [[percutaneous coronary intervention]], and/or [[coronary artery bypass surgery]]. In the majority of cases, SCAD may be managed successfully with medical treatment alone in the absence of ongoing [[myocardial ischemia]] or [[hemodynamic instability]].<ref name="pmid25294399">{{cite journal| author=Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D et al.| title=Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. | journal=Circ Cardiovasc Interv | year= 2014 | volume= 7 | issue= 5 | pages= 645-55 | pmid=25294399 | doi=10.1161/CIRCINTERVENTIONS.114.001760 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25294399 }} </ref><ref name="pmid22800851">{{cite journal| author=Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ et al.| title=Clinical features, management, and prognosis of spontaneous coronary artery dissection. | journal=Circulation | year= 2012 | volume= 126 | issue= 5 | pages= 579-88 | pmid=22800851 | doi=10.1161/CIRCULATIONAHA.112.105718 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22800851 }} </ref> Initial conservative management typically includes antithrombotic therapy with [[heparin]], [[aspirin]], [[clopidogrel]] and [[glycoprotein IIb/IIIa inhibitors]], and antiischemic therapy with [[beta blockers]] and [[nitrate]]s. However, the use of antithrombotic therapy may increase the risk of bleeding in the false lumen causing an expansion of the intramural hematoma, resulting in a decreased flow through the true lumen.<ref name="Vrints-2010">{{Cite journal | last1 = Vrints | first1 = CJ. | title = Spontaneous coronary artery dissection. | journal = Heart | volume = 96 | issue = 10 | pages = 801-8 | year = 2010 | doi = 10.1136/hrt.2008.162073 | PMID = 20448134 }}</ref> [[Fibrinolytic]]s should be avoided. [[Calcium channel blocker]]s may offer relief in [[coronary artery spasm]]. | ||
==[[Beta Blockers]]== | ===[[Beta Blockers]]=== | ||
There is a general agreement that [[beta blockers]] take the most important place in the medical management of SCAD patients. [[Beta blockers]] may improve the outcomes of SCAD patients with reducing coronary [[arterial shear stress]] likewise [[aortic dissection]]. <ref name="pmid21810861">{{cite journal| author=Nienaber CA, Powell JT| title=Management of acute aortic syndromes. | journal=Eur Heart J | year= 2012 | volume= 33 | issue= 1 | pages= 26-35b | pmid=21810861 | doi=10.1093/eurheartj/ehr186 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21810861 }} </ref> Furthermore, [[beta blockers]] should be used in these group of patients in order to reduce complications of myocardial infarction. <ref name="pmid26811316">{{cite journal| author=Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN et al.| title=Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 9 | pages= 916-47 | pmid=26811316 | doi=10.1161/CIR.0000000000000351 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26811316 }} </ref> <ref name="pmid25249586">{{cite journal| author=Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR et al.| title=2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= 130 | issue= 25 | pages= 2354-94 | pmid=25249586 | doi=10.1161/CIR.0000000000000133 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25249586 }} </ref> | There is a general agreement that [[beta blockers]] take the most important place in the medical management of SCAD patients. [[Beta blockers]] may improve the outcomes of SCAD patients with reducing coronary [[arterial shear stress]] likewise [[aortic dissection]]. <ref name="pmid21810861">{{cite journal| author=Nienaber CA, Powell JT| title=Management of acute aortic syndromes. | journal=Eur Heart J | year= 2012 | volume= 33 | issue= 1 | pages= 26-35b | pmid=21810861 | doi=10.1093/eurheartj/ehr186 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21810861 }} </ref> Furthermore, [[beta blockers]] should be used in these group of patients in order to reduce complications of myocardial infarction. <ref name="pmid26811316">{{cite journal| author=Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN et al.| title=Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 9 | pages= 916-47 | pmid=26811316 | doi=10.1161/CIR.0000000000000351 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26811316 }} </ref> <ref name="pmid25249586">{{cite journal| author=Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR et al.| title=2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= 130 | issue= 25 | pages= 2354-94 | pmid=25249586 | doi=10.1161/CIR.0000000000000133 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25249586 }} </ref> | ||
Revision as of 15:38, 5 December 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
Medical Therapy
There are no specific guidelines regarding the optimal management of spontaneous coronary artery dissection. Based on the clinical and angiographic scenario, treatment options include conservative medical regimens similar to that for acute coronary syndrome, percutaneous coronary intervention, and/or coronary artery bypass surgery. In the majority of cases, SCAD may be managed successfully with medical treatment alone in the absence of ongoing myocardial ischemia or hemodynamic instability.[1][2] Initial conservative management typically includes antithrombotic therapy with heparin, aspirin, clopidogrel and glycoprotein IIb/IIIa inhibitors, and antiischemic therapy with beta blockers and nitrates. However, the use of antithrombotic therapy may increase the risk of bleeding in the false lumen causing an expansion of the intramural hematoma, resulting in a decreased flow through the true lumen.[3] Fibrinolytics should be avoided. Calcium channel blockers may offer relief in coronary artery spasm.
Beta Blockers
There is a general agreement that beta blockers take the most important place in the medical management of SCAD patients. Beta blockers may improve the outcomes of SCAD patients with reducing coronary arterial shear stress likewise aortic dissection. [4] Furthermore, beta blockers should be used in these group of patients in order to reduce complications of myocardial infarction. [5] [6]
References
- ↑ Saw J, Aymong E, Sedlak T, Buller CE, Starovoytov A, Ricci D; et al. (2014). "Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes". Circ Cardiovasc Interv. 7 (5): 645–55. doi:10.1161/CIRCINTERVENTIONS.114.001760. PMID 25294399.
- ↑ Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ; et al. (2012). "Clinical features, management, and prognosis of spontaneous coronary artery dissection". Circulation. 126 (5): 579–88. doi:10.1161/CIRCULATIONAHA.112.105718. PMID 22800851.
- ↑ Vrints, CJ. (2010). "Spontaneous coronary artery dissection". Heart. 96 (10): 801–8. doi:10.1136/hrt.2008.162073. PMID 20448134.
- ↑ Nienaber CA, Powell JT (2012). "Management of acute aortic syndromes". Eur Heart J. 33 (1): 26–35b. doi:10.1093/eurheartj/ehr186. PMID 21810861.
- ↑ Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN; et al. (2016). "Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association". Circulation. 133 (9): 916–47. doi:10.1161/CIR.0000000000000351. PMID 26811316.
- ↑ Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Ganiats TG, Holmes DR; et al. (2014). "2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 130 (25): 2354–94. doi:10.1161/CIR.0000000000000133. PMID 25249586.