Spontaneous coronary artery dissection treatment approach
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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.
Synonyms and keywords: SCAD
Overview
Treatment Approach
- Pharmacologic medical therapies for spontaneous coronary artery dissection pursues three main goals:[1]
- Antianginal therapy
- Prevention of recurrence
- Assessment and management of extra coronary vascular abnormalities
- Improvement of quality of life
Management of Chest Pain
- To manage of chest pain in patients with SCAD consider the followings:[1]
- Antianginal medications
- Consider further testing to rule out underlying ischemia
- Consider other possible diagnoses
Prevention
- To reduce the risk of SCAD recurrence, the following should be considered:[1]
- Beta-blocker therapy
- Management of hypertension
- Maintaining of physical activity
Algorithm for management of acute spontaneous coronary artery dissection: A Scientific Statement From the American Heart Association
Algorithm for management of acute spontaneous coronary artery dissection.[2]
Management of Acute Spontaneous Coronary Artery Dissection | |||||||||||||||||||||||||||||||||||||||
| Clinically stable without high-risk anatomy | Clinically stable with high-risk anatomy (i.e., left main or proximal 2-vessel dissection) | Active/ongoing ischemia or hemodynamic instability | |||||||||||||||||||||||||||||||||||||
❑ Conservative therapy ❑ Monitor as inpatient 3–5 days | ❑ Consider CABG ❑ Conservative Rx may be reasonable | ❑ Consider PCI if feasible, OR ❑ Urgent CABG (based on technical considerations and local expertise) | |||||||||||||||||||||||||||||||||||||
Abbreviations:
CABG, coronary artery bypass grafting;
PCI, percutaneous coronary intervention;
Rx, management.
References
- ↑ 1.0 1.1 1.2 Kim, Esther S.H.; Longo, Dan L. (2020). "Spontaneous Coronary-Artery Dissection". New England Journal of Medicine. 383 (24): 2358–2370. doi:10.1056/NEJMra2001524. ISSN 0028-4793.
- ↑ 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: CIR.0000000000000564. doi:10.1161/CIR.0000000000000564. ISSN 0009-7322.