Materiały źródłowe

• #1 Spontaneous coronary artery dissection (SCAD) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/symptoms-causes/syc-20353711

  Spontaneous coronary artery dissection is an emergency condition that occurs when a tear forms in a wall of a heart artery. Spontaneous coronary artery dissection also is called SCAD. […] SCAD can cause sudden death if it isn’t treated promptly. Get emergency medical help if you have heart attack symptoms even if you think you aren’t at risk of a heart attack. […] A possible complication of SCAD is heart attack. SCAD slows or stops blood flow through an artery. This weakens the heart and may lead to a heart attack. […] Even with successful treatment, SCAD can happen more than once. It might happen soon after the first episode or years later. People who have SCAD also may have a higher risk of other heart problems. These problems include heart failure due to the heart attack damage. […] Spontaneous coronary artery dissection (SCAD) care at Mayo Clinic.

• #2 Spontaneous Coronary Artery Dissection: Clinical Considerations in Diagnosis and Treatment – American College of Cardiology

  https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/20/11/41/Spontaneous-Coronary-Artery-Dissection

  Spontaneous coronary artery dissection (SCAD) is a unique clinical entity and an important cause of myocardial infarction (MI), particularly among young and middle-aged women. SCAD is defined as a non-iatrogenic, non-traumatic separation of the coronary artery wall, not associated with atherosclerosis. The predominant mechanism of myocardial injury is coronary artery obstruction caused by an intramural hematoma (IMH) or intimal disruption compromising the true lumen at the site of dissection. Early and accurate diagnosis of SCAD is vital because the management strategy employed in this condition significantly differs from that of atherosclerotic disease. Because patients with SCAD are generally younger and possess less-conventional cardiovascular risk factors, they are often more prone to misdiagnosis. Coronary angiography is the first-line diagnostic tool for patients presenting with acute coronary syndrome due to suspected SCAD and should be performed as early as possible. A conservative treatment strategy is recommended in most cases, which includes an extended inpatient monitoring period of 3-5 days. The backbone of long-term medical therapy in SCAD is a combination of aspirin and beta-blocker. Beta-blocker use has been associated with a lower risk of recurrent SCAD (hazard ratio 0.36) and is therefore an essential part of long-term therapy at our institution. Revascularization for SCAD should be considered in patients exhibiting active myocardial ischemia, hemodynamic instability, or left main dissection, in whom conservative management is an unsatisfactory alternative. According to observational studies, percutaneous coronary intervention (PCI) for treatment of SCAD is associated with lower success rates and higher rates of complications compared with PCI for atherosclerotic CAD. In SCAD, affected coronary arteries are more susceptible to iatrogenic dissections. There are several proposed strategies aimed at improving the success rate of PCI in SCAD. SCAD is an enigmatic disease, and our understanding of the disease has progressed in recent years, largely owing to several registries including CanSCAD. Additional studies are required to refine and unify our treatment approaches to patients with SCAD.

• #3 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  Spontaneous coronary artery dissection (SCAD) is a tear in the wall of the epicardial coronary artery not caused by trauma, coronary intervention, or atherosclerotic plaque rupture. […] SCAD is an emerging cause of acute coronary syndrome (ACS) in young females without any known cardiovascular risk factors. […] Diagnosis is confirmed primarily by cardiac catheterization and coronary angiogram; intravascular imaging can be done if a coronary angiogram is inconclusive. […] General and interventional cardiologists, advanced cardiovascular imaging specialists, and cardiac surgeons should be on board for the management. […] The most common cause of ACS in the general population is rupture of atherosclerotic coronary plaque leading to superimposed thrombosis, obstruction to the distal coronary flow, and coronary ischemia. SCAD leads to the formation of an intramural hematoma, compression of the true lumen, and obstruction to the distal coronary flow, resulting in ACS.

• #4 SCAD Research, Inc Spontaneous Coronary Artery Dissection | What is SCAD

  https://scadresearch.org/about/

  Spontaneous Coronary Artery Dissection (SCAD) is a little known and poorly understood type of a heart attack caused when a sudden tear occurs within the layers of one or more coronary arteries. This tear partially or completely blocks blood flow to the heart and causes a heart attack. SCAD may also lead to cardiac arrest and sometimes death. Unlike a traditional heart attack caused by blockage due to plaque buildup over a lifetime, SCAD is a completely distinct and different artery blockage. SCAD patients typically have minimal or no risk factors for atherosclerosis. SCAD can recur. […] SCAD is the #1 cause of heart attacks among women under the age of 50 as well as the #1 cause of heart attacks in pregnant women and new mothers. Most individuals with SCAD are YOUNG, HEALTHY, ACTIVE women who have NO FAMILY HISTORY OF HEART DISEASE. The average age is only 42. Although less common, SCAD can affect MEN too.

• #5 Spontaneous Coronary Artery Dissection (SCAD) | Saint Luke’s Health System

  https://www.saintlukeskc.org/condition/spontaneous-coronary-artery-dissection-scad

  SCAD is caused by a sudden tear or split in the coronary artery wall, which results in blood filling within the tear and blocking blood flow in the artery. […] SCAD is the number one cause of heart attacks in young women under the age of 50. […] Most individuals with SCAD are young, healthy, and active with no family history of heart disease. […] Medical conditions and situations which increase the risk of SCAD include abnormalities of the blood vessels such as fibromuscular dysplasia (FMD), inherited connective tissue diseases such as Ehlers-Danlos syndrome or Marfans syndrome, severe high blood pressure, extreme physical exercise, and severe emotional stress.

• #6 What we know about Spontaneous Coronary Artery Dissection (SCAD) | OHSU

  https://www.ohsu.edu/womens-health/womens-heart-health-leading-cause-heart-attacks-young-women

  When you ask people what they think is the number one cause of death for women, heart disease is not always their first guess. And when asked to name a leading cause of heart attacks for women under 50, you dont often hear mention of a lesser-known condition called Spontaneous Coronary Artery Dissection, or SCAD. […] However, SCAD is more common in women and people assigned female at birth (AFAB) than in men, and it is the number one cause of heart attacks during pregnancy and early postpartum. It can happen at any age, but most commonly affects women in their 40s and 50s. […] SCAD is an emergency condition where a tear develops in a wall of a blood vessel that supplies blood to the heart. Blood can collect in the walls of the torn artery, forming a blood clot. This puts pressure on the artery, which becomes smaller as the pressure in the walls builds up. Blood flow to the heart can then slow down or stop, causing a heart attack.

• #7 Spontaneous Coronary Artery Dissection (SCAD) – CardioNerds

  https://www.cardionerds.com/65-case-report-spontaneous-coronary-artery-dissection-scad-requiring-heart-transplantation-ucla/

  CardioNerds (Amit Goyal Daniel Ambinder) join join UCLA cardiology fellows (Jay Patel, Hillary Shapiro, and Ruth Hsiao) for some beach bonfire in Santa Monica! They discuss a challenging case of Spontaneous Coronary Artery Dissection (SCAD) requiring heart transplantation. […] A woman in her late 40s presented with a one day history of intermittent chest pain. […] SCAD stands for spontaneous coronary artery dissection. It is an acute coronary event and is defined as a spontaneous separation of the coronary artery wall that is not iatrogenic or related to trauma. It is an important cause of acute myocardial infarction. […] Women comprise 87%-95% of SCAD patients with a mean age of presentation between 44-53 years, just like the patient in this case. […] In some studies, the prevalence of SCAD appears around 4% of all patients presenting with ACS and up to 35% in women 50 years or under presenting with ACS.

• #8 Spontaneous Coronary Artery Dissection: An Elusive Disease of the Coronaries | Methodist DeBakey Cardiovascular J

  https://journal.houstonmethodist.org/articles/10.14797/mdcvj.1129

  Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction. Diagnosis and management of SCAD can be challenging; therefore, clinicians should consider SCAD in the differential diagnosis, especially in young women presenting with acute coronary syndrome (ACS). […] SCAD is defined as noniatrogenic epicardial coronary artery dissection that is not associated with trauma or atherosclerosis. […] The mechanism is thought to be development of intimal tear or intramural hematoma formation within the tunica media that causes compression of the true lumen of the coronary artery, leading to myocardial injury. […] Between 1% and 4% of ACS cases are from SCAD. An important cause of myocardial infarction (MI) in young women, it accounts for up to 35% of ACS cases in women 50 years of age and is the most common cause of pregnancy-associated MI.

• #9 Spontaneous Coronary Artery Dissection (SCAD) – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/spontaneous-coronary-artery-dissection-scad/

  Spontaneous coronary artery dissection (SCAD), once thought of as a rare zebra diagnosis that was universally fatal, is now being increasingly recognized as a cause of acute coronary syndrome (ACS), particularly in women due to increased vigilance, greater utilization of coronary angiography and advanced imaging. […] SCAD is defined as a non-traumatic and non-iatrogenic tear in the coronary arterial wall. […] It is most common among women typically lacking classic cardiac disease risk factors. […] SCAD has also been identified as the most common cause of pregnancy-associated MI. […] SCAD has a unique demographic, risk factor profile and women are at greater risk. […] Pregnancy-associated SCAD is the most common cause of MI among pregnant and postpartum patients. […] Diagnosis is difficult and patients may be mistakenly discharged or have an incomplete work-up done due to their relatively young age and lack of risk factors for ACS.

• #10 Spontaneous Coronary Artery Dissection (SCAD) Treatment at Emory Heart & Vascular

  https://www.emoryhealthcare.org/services/heart-vascular/conditions/spontaneous-coronary-artery-dissection

  At Emory Heart Vascular, we bring together a multidisciplinary team to treat spontaneous coronary artery dissection. Our goal is to improve your blood flow, manage your pain and prevent another SCAD event. Our experts offer a full range of treatments to help you. […] Our specialists will prescribe medications and suggest lifestyle changes as they closely monitor your condition. […] Spontaneous coronary artery dissection symptoms can feel like a heart attack even if you’re not having a heart attack. […] We don’t know the underlying cause behind spontaneous coronary artery dissection. But, several factors can increase your risk. […] SCAD risk factors include: Being female, Connective tissue genetic conditions: SCAD occurs more often in people who have Ehlers-Danlos or Marfan syndrome, Childbirth: SCAD can occur during pregnancy or in the first few weeks after delivery. It may be caused by hormonal changes and stress on your blood vessels, Fibromuscular dysplasia (FMD): This condition weakens your mid-sized arteries. It affects females more than males, High blood pressure: Severe blood pressure increases your SCAD risk, Illegal drug use: Cocaine and other illegal drugs may increase your SCAD risk, Stress: Extreme stress can trigger SCAD. This can include significant emotional distress or intense physical activity or exercise.

• #11 Spontaneous Coronary Artery Dissection (SCAD) | Saint Luke’s Health System

  https://www.saintlukeskc.org/condition/spontaneous-coronary-artery-dissection-scad

  SCAD is caused by a sudden tear or split in the coronary artery wall, which results in blood filling within the tear and blocking blood flow in the artery. […] SCAD is the number one cause of heart attacks in young women under the age of 50. […] Most individuals with SCAD are young, healthy, and active with no family history of heart disease. […] Medical conditions and situations which increase the risk of SCAD include abnormalities of the blood vessels such as fibromuscular dysplasia (FMD), inherited connective tissue diseases such as Ehlers-Danlos syndrome or Marfans syndrome, severe high blood pressure, extreme physical exercise, and severe emotional stress.

• #12 Women Are At A Higher Risk For Spontaneous Coronary Artery Dissection. Here’s What You Need To Know | Henry Ford Health – Detroit, MI

  https://www.henryford.com/blog/2024/06/scad

  Spontaneous coronary artery dissection (SCAD) occurs when a tear forms in the artery wall of the heart without warning. While SCAD is an increasingly recognized cause of a heart attack, approximately 87-95% of all cases occur in women. […] SCAD is likely influenced by a combination of factors that include sex, underlying health conditions, and genetics as well as environmental, physical, or emotional stressors, says Dr. Jabri. […] The lack of blood flow to the heart that occurs with SCAD can cause heart attack symptoms including: chest pain, shortness of breath, excessive sweating, feeling dizzy, pain in the arms, shoulders, back or jaw. […] Patients who have had SCAD will need to avoid extreme endurance training, exercising to exhaustion, elite competitive sports and vigorous exertion in extreme temperatures to prevent another SCAD episode, says Dr. Jabri. […] If you have had SCAD or are looking to avoid SCAD in the future, making lifestyle modifications can lower your risk.

• #13 Spontaneous Coronary Artery Dissection: An Elusive Disease of the Coronaries | Methodist DeBakey Cardiovascular J

  https://journal.houstonmethodist.org/articles/10.14797/mdcvj.1129

  Risk factors include female gender, pregnancy, fibromuscular dysplasia connective tissue disorders, hormonal therapies, corticosteroids, and emotional and physical stressors. Traditional risk factors of MI are generally few or absent. […] Chest pain, the most common presentation of SCAD, rarely presents with cardiogenic shock, ventricular arrythmias, and sudden cardiac death. […] Diagnosis of SCAD is generally made on coronary angiography. Based on its angiographic appearance, it has three types of Yip-Saw classification: (1) multiple radiolucent lumens or arterial wall contrast staining; (2) presence of diffuse stenosis of varying severity and length (most commonly seen); and (3) focal or tubular stenosis mimics atherosclerosis. […] While optimal management is up for debate, conservative medical therapy is recommended in most cases. Healing of SCAD lesion occurs in a majority of patients (70-97%) after conservative management, but recurrence is common.

• #14 Spontaneous Coronary Artery Dissection (SCAD)

  https://my.clevelandclinic.org/health/diseases/17503-spontaneous-coronary-artery-dissection-scad

  Postpartum and postmenopausal people are most at risk for spontaneous coronary artery dissection (SCAD). This life-threatening condition requires immediate care. SCAD increases your risk of acute coronary syndrome. This is a type of coronary artery disease that causes chest pain or angina. Youre also at risk of having a life-threatening heart attack. SCAD is also more likely to occur around the time of menstruation or during postmenopause. These risk factors suggest that fluctuations in female hormones may play a role. SCAD is a medical emergency. Call 911 if you experience heart attack symptoms, such as: Dizziness or fainting (syncope). Excessive sweating (hyperhidrosis) or clamminess. Heart palpitations or arrhythmia. Musculoskeletal pain in your arm, shoulder or jaw. Nausea and vomiting or indigestion. Shortness of breath. As many as 3 in 4 people who develop SCAD improve with medications, such as those used to: Manage blood pressure (beta blockers). Manage high cholesterol. Prevent blood clots (antiplatelet medications). An estimated 14% of people have severe SCAD that requires urgent, in-hospital treatments, which may include: Cardiac catheterization and coronary angioplasty and stent (interventional procedures). Coronary artery bypass grafting (CABG). Left ventricular assist device (mechanical circulatory support) or implantable cardioverter defibrillator (ICD). Heart transplant (extremely rare). If youve had an artery tear, you may need to restrict certain physical activities and strength training to prevent another tear. Your healthcare provider may also recommend cardiac rehabilitation. This rehab improves your heart health and teaches you how to exercise safely. SCAD can be life-threatening, claiming the lives of up to 5% of people who develop it. You should call 911 anytime you experience heart attack symptoms. If tests indicate SCAD, your healthcare provider will discuss treatment options. Even with treatment, you have a higher chance of having another artery tear. Your provider will closely monitor your heart health to lower this risk.

• #15 Coronary Artery Dissection: Not Just a Heart Attack | American Heart Association

  https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks/coronary-artery-dissection-not-just-a-heart-attack

  Spontaneous coronary artery dissection (SCAD) happens when an artery wall suddenly tears. […] SCAD can cause a heart attack. […] People who have a SCAD are at high risk of another. […] Recognizing the symptoms of a heart attack is crucial for SCAD patients. Warning signs may include: Chest pain or pressure, Shortness of breath, Profuse sweating, Dizziness. […] Treatment for SCAD patients may differ from other heart attack patients. Typical heart attack patients may need a stent to hold the artery open or bypass surgery. SCAD treatment may be more conservative with blood pressure control and medication to lower cholesterol. SCAD patients who are unstable with ongoing signs of a heart attack may need stent placement or bypass surgery. […] Health care professionals may spot the signs of SCAD using: Enzyme markers, Angiogram, Intravascular ultrasound, Optical coherence tomography, which shows the artery from the inside out.

• #16 Women Are At A Higher Risk For Spontaneous Coronary Artery Dissection. Here’s What You Need To Know | Henry Ford Health – Detroit, MI

  https://www.henryford.com/blog/2024/06/scad

  Spontaneous coronary artery dissection (SCAD) occurs when a tear forms in the artery wall of the heart without warning. While SCAD is an increasingly recognized cause of a heart attack, approximately 87-95% of all cases occur in women. […] SCAD is likely influenced by a combination of factors that include sex, underlying health conditions, and genetics as well as environmental, physical, or emotional stressors, says Dr. Jabri. […] The lack of blood flow to the heart that occurs with SCAD can cause heart attack symptoms including: chest pain, shortness of breath, excessive sweating, feeling dizzy, pain in the arms, shoulders, back or jaw. […] Patients who have had SCAD will need to avoid extreme endurance training, exercising to exhaustion, elite competitive sports and vigorous exertion in extreme temperatures to prevent another SCAD episode, says Dr. Jabri. […] If you have had SCAD or are looking to avoid SCAD in the future, making lifestyle modifications can lower your risk.

• #17 Learning About Spontaneous Coronary Artery Dissection (SCAD) | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.learning-about-spontaneous-coronary-artery-dissection-scad.ack1533

  A spontaneous coronary artery dissection (SCAD) is a condition that may cause a heart attack. […] SCAD occurs most often in young women. It usually happens without warning. […] SCAD can be hard to diagnose. […] Your care team will do tests and watch for more symptoms or problems. You may stay in the hospital for a few days. […] You may take medicines, such as beta-blockers, to help prevent another SCAD. […] Ask your doctor if cardiac rehab is right for you. […] Treatment for a SCAD isn’t the same as treatment for most heart attacks, which are caused by blood clots. […] Talk with your doctor before you exercise again. Your doctor might suggest avoiding heavy exercise for a period of time. […] Tell all of your doctors that you’ve had a SCAD. […] If you plan to get pregnant, work with your doctor to plan a safe pregnancy and delivery. […] Talk to your doctor if you keep having chest pain. Your doctor may want to do more tests and try medicine to relieve your pain.

• #18 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  The left anterior descending artery is the most affected by spontaneous coronary dissection. […] The etiology of spontaneous coronary artery dissection is unclear and hypothesized to be multifactorial. […] Spontaneous coronary artery dissection is the most common cause of ACS in young women without any conventional cardiovascular risk factors. […] Women with pregnancy-related spontaneous coronary artery dissection have a poor prognosis. […] Studies have also shown a possible association between extreme physical or emotional stress and SCAD. […] The primary presentation of spontaneous coronary artery dissection is anginal chest pain in 90%, followed by an angina equivalent. […] The cardiovascular system examination may reveal sinus tachycardia and S3 gallop rhythm with anterior wall MI and congestive heart failure, sinus bradycardia, and complete heart block when the right coronary artery is involved.

• #19 Spontaneous Coronary Artery Dissection: Clinical Considerations in Diagnosis and Treatment – American College of Cardiology

  https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/20/11/41/Spontaneous-Coronary-Artery-Dissection

  Spontaneous coronary artery dissection (SCAD) is a unique clinical entity and an important cause of myocardial infarction (MI), particularly among young and middle-aged women. SCAD is defined as a non-iatrogenic, non-traumatic separation of the coronary artery wall, not associated with atherosclerosis. The predominant mechanism of myocardial injury is coronary artery obstruction caused by an intramural hematoma (IMH) or intimal disruption compromising the true lumen at the site of dissection. Early and accurate diagnosis of SCAD is vital because the management strategy employed in this condition significantly differs from that of atherosclerotic disease. Because patients with SCAD are generally younger and possess less-conventional cardiovascular risk factors, they are often more prone to misdiagnosis. Coronary angiography is the first-line diagnostic tool for patients presenting with acute coronary syndrome due to suspected SCAD and should be performed as early as possible. A conservative treatment strategy is recommended in most cases, which includes an extended inpatient monitoring period of 3-5 days. The backbone of long-term medical therapy in SCAD is a combination of aspirin and beta-blocker. Beta-blocker use has been associated with a lower risk of recurrent SCAD (hazard ratio 0.36) and is therefore an essential part of long-term therapy at our institution. Revascularization for SCAD should be considered in patients exhibiting active myocardial ischemia, hemodynamic instability, or left main dissection, in whom conservative management is an unsatisfactory alternative. According to observational studies, percutaneous coronary intervention (PCI) for treatment of SCAD is associated with lower success rates and higher rates of complications compared with PCI for atherosclerotic CAD. In SCAD, affected coronary arteries are more susceptible to iatrogenic dissections. There are several proposed strategies aimed at improving the success rate of PCI in SCAD. SCAD is an enigmatic disease, and our understanding of the disease has progressed in recent years, largely owing to several registries including CanSCAD. Additional studies are required to refine and unify our treatment approaches to patients with SCAD.

• #20 Spontaneous Coronary Artery Dissection (SCAD) – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/spontaneous-coronary-artery-dissection-scad/

  Accurate diagnosis in the acute stages of ACS is paramount as the management and investigation of SCAD is different from other causes of ACS. […] Once SCAD is suspected, angiography remains the first-line diagnostic modality. […] Conservative Management: Mainstay of management in those without high-risk features. […] Majority of patients have angiographic healing of SCAD lesions without intervention. […] SCAD patients with high-risk features: […] High-Risk Features: Left Main Coronary Artery Dissection, Ongoing or Recurrent Ischemia or Chest Pain, Ventricular Tachycardia or Ventricular Fibrillation, Cardiogenic Shock. […] PCI: Due to coronary artery fragility observed in SCAD, PCI is associated with increased risk of complications and variables outcomes. […] CABG: Described for SCAD patients with left main or proximal dissection, those with failure of attempted PCI, and those with refractory ischemia despite conservative approach.

• #21 Spontaneous coronary artery dissection (SCAD) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/diagnosis-treatment/drc-20353716

  SCAD is usually diagnosed in an emergency setting. You may be asked questions about your personal and family medical history. Tests are done to check your heart. […] Tests to diagnose SCAD are similar to tests used to detect a heart attack. They may include: […] A coronary angiogram can diagnose SCAD. It also can show any twisted arteries. […] Our caring team of Mayo Clinic experts can help you with your Spontaneous coronary artery dissection (SCAD)-related health concerns. […] The goals of SCAD treatment are to: Restore blood flow to the heart. Manage chest pain. Prevent SCAD from happening again. […] Treatment may include medicines and a procedure or surgery to open the artery and restore blood flow. Sometimes SCAD heals on its own. […] Some people with SCAD need a surgery or procedure to fix the artery and improve blood flow to the heart.

• #22 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  Spontaneous coronary artery dissection (SCAD) is a tear in the wall of the epicardial coronary artery not caused by trauma, coronary intervention, or atherosclerotic plaque rupture. […] SCAD is an emerging cause of acute coronary syndrome (ACS) in young females without any known cardiovascular risk factors. […] Diagnosis is confirmed primarily by cardiac catheterization and coronary angiogram; intravascular imaging can be done if a coronary angiogram is inconclusive. […] General and interventional cardiologists, advanced cardiovascular imaging specialists, and cardiac surgeons should be on board for the management. […] The most common cause of ACS in the general population is rupture of atherosclerotic coronary plaque leading to superimposed thrombosis, obstruction to the distal coronary flow, and coronary ischemia. SCAD leads to the formation of an intramural hematoma, compression of the true lumen, and obstruction to the distal coronary flow, resulting in ACS.

• #23 Spontaneous Coronary Artery Dissection (SCAD) | Treatment & Diagnosis | UH Harrington Heart & Vascular Institute | University Hospitals | Cleveland, Ohio | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection (SCAD) is an uncommon emergency condition in which a tear forms in an artery in the heart, usually leading to a heart attack. […] Because SCAD is a medical emergency that can lead to a heart attack and even sudden death, obtaining medical care as quickly as possible is critical. Always seek emergency attention immediately if you experience heart attack symptoms, even if you believe you are not at risk for having a heart attack. […] The first step in the diagnosis of SCAD is to determine if a heart attack occurred and look for damage to the heart muscle. Tests used in the emergency room include an electrocardiogram (ECG) and blood tests that detect heart muscle damage, such as the cardiac enzyme troponin test. […] In most cases, if a patient is being treated for SCAD, they have just had a heart attack. Therefore, the initial goal of treatment it to get blood flow restored to the heart muscle again. Treatment depends on the patient’s specific, unique condition, including the size and location of the arterial dissection and their symptoms.

• #24 Coronary Artery Dissection: Not Just a Heart Attack | American Heart Association

  https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks/coronary-artery-dissection-not-just-a-heart-attack

  Spontaneous coronary artery dissection (SCAD) happens when an artery wall suddenly tears. […] SCAD can cause a heart attack. […] People who have a SCAD are at high risk of another. […] Recognizing the symptoms of a heart attack is crucial for SCAD patients. Warning signs may include: Chest pain or pressure, Shortness of breath, Profuse sweating, Dizziness. […] Treatment for SCAD patients may differ from other heart attack patients. Typical heart attack patients may need a stent to hold the artery open or bypass surgery. SCAD treatment may be more conservative with blood pressure control and medication to lower cholesterol. SCAD patients who are unstable with ongoing signs of a heart attack may need stent placement or bypass surgery. […] Health care professionals may spot the signs of SCAD using: Enzyme markers, Angiogram, Intravascular ultrasound, Optical coherence tomography, which shows the artery from the inside out.

• #25 How and when to suspect spontaneous coronary artery dissection: novel insights from a single-centre series on prevalence and angiographic appearance | EuroIntervention

  https://eurointervention.pcronline.com/article/how-and-when-to-suspect-spontaneous-coronary-artery-dissection-novel-insights-from-a-single-centre-series-on-prevalence-and-angiographic-appearance

  Spontaneous coronary artery dissection (SCAD) is an underdiagnosed entity of acute coronary syndrome (ACS). Its prevalence remains unclear due to a challenging diagnosis, particularly in instances of intramural haematoma without intimal rupture. SCAD accounts for approximately one third of ACS in young women with 1 CRF. The combination of specific angiographic signs and OCT imaging facilitates the diagnosis of ambiguous cases without intimal rupture. SCAD is a severe and underdiagnosed clinical entity that frequently presents as an acute coronary syndrome (ACS), affecting young women predominantly. The overall prevalence remains unclear, varying from 0.1% to 1.1% in most angiographic series. Several reasons indicate that this is an underdiagnosed condition. The well-known limitations of coronary angiography in visualising the vessel wall contribute to the misdiagnosis of SCAD, especially in cases of intramural haematoma without intimal rupture. The pathognomonic appearance of dissection with intimal rupture as a radiolucent flap is easily recognisable on angiography. In contrast, the assessment of luminal narrowing in case of intramural haematoma is more subtle, and remains a challenge for clinicians confronted with a suspicion of SCAD. The combination of specific angiographic features facilitates the diagnosis and may help the clinician confronted with the suspicion of a SCAD diagnosis.

• #26 Spontaneous Coronary Artery Dissection: An Elusive Disease of the Coronaries | Methodist DeBakey Cardiovascular J

  https://journal.houstonmethodist.org/articles/10.14797/mdcvj.1129

  Risk factors include female gender, pregnancy, fibromuscular dysplasia connective tissue disorders, hormonal therapies, corticosteroids, and emotional and physical stressors. Traditional risk factors of MI are generally few or absent. […] Chest pain, the most common presentation of SCAD, rarely presents with cardiogenic shock, ventricular arrythmias, and sudden cardiac death. […] Diagnosis of SCAD is generally made on coronary angiography. Based on its angiographic appearance, it has three types of Yip-Saw classification: (1) multiple radiolucent lumens or arterial wall contrast staining; (2) presence of diffuse stenosis of varying severity and length (most commonly seen); and (3) focal or tubular stenosis mimics atherosclerosis. […] While optimal management is up for debate, conservative medical therapy is recommended in most cases. Healing of SCAD lesion occurs in a majority of patients (70-97%) after conservative management, but recurrence is common.

• #27 Spontaneous coronary artery dissection (SCAD) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/diagnosis-treatment/drc-20353716

  SCAD is usually diagnosed in an emergency setting. You may be asked questions about your personal and family medical history. Tests are done to check your heart. […] Tests to diagnose SCAD are similar to tests used to detect a heart attack. They may include: […] A coronary angiogram can diagnose SCAD. It also can show any twisted arteries. […] Our caring team of Mayo Clinic experts can help you with your Spontaneous coronary artery dissection (SCAD)-related health concerns. […] The goals of SCAD treatment are to: Restore blood flow to the heart. Manage chest pain. Prevent SCAD from happening again. […] Treatment may include medicines and a procedure or surgery to open the artery and restore blood flow. Sometimes SCAD heals on its own. […] Some people with SCAD need a surgery or procedure to fix the artery and improve blood flow to the heart.

• #28 Spontaneous coronary artery dissection: Principles of management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/11/623

  Spontaneous coronary artery dissection (SCAD) is an acute noniatrogenic tear in the coronary arterial wall, leading to disruption of coronary blood flow and myocardial infarction. […] SCAD is primarily managed medically in clinically stable patients. […] Long-term management includes screening for fibromuscular dysplasia and other arteriopathies, monitoring for recurrence, and cardiac rehabilitation. […] Observational studies have consistently demonstrated that PCI in the setting of SCAD is associated with worse outcomes and high complication rates. […] In a retrospective study of 189 patients with SCAD, the procedural failure rate was 53% in those managed with PCI. […] Patients should therefore be monitored closely for new or worsening cardiac symptoms, which should prompt further testing. […] Cardiac rehabilitation is an important component of management following SCAD, but it remains significantly underused. […] We recommend referring all patients with SCAD for cardiac rehabilitation, including young women without other comorbidities.

• #29 Management of SCAD | Spontaneous Coronary Artery Dissection (SCAD)

  https://scad.ubc.ca/management-of-scad/

  The long-term prognosis for SCAD survivors after their initial SCAD presentation is good. Recurrent SCAD events, however, are frequent and these patients must be followed closely. Conservative medical management for stable patients with resolved ischemia is typical. Revascularization via percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) may be necessary for a small percentage of patients. […] Medical management of SCAD deviates from standard ACS therapy. In particular, thrombolytic therapy should be avoided for patients with SCAD. Therefore, early coronary angiography to establish SCAD is important. […] Beta-blockers offer benefits in aortic dissection by reducing arterial wall shear stress. Extrapolating these benefits, we routinely administer beta-blockers for SCAD, both acutely and long-term.

• #30 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  The observation that SCAD mostly affects young women, and that SCAD is the most common cause of pregnancy-associated MI suggest a role of female hormones in SCAD susceptibility. […] Multiple studies have shown a high prevalence of FMD and other extra-coronary vascular abnormalities (up to 86%) among patients with SCAD. […] As most cases of SCAD heal spontaneously, where possible, a conservative approach should be used. […] In the Canadian SCAD registry of 750 patients, 86.4% were managed conservatively, with only 2.3% of these patients subsequently requiring invasive treatment. […] The role of antiplatelet therapy in SCAD has been controversial. […] In their scientific statements, the AHA and ESC suggested at least a single antiplatelet agent (aspirin), to be used acutely. […] In a systematic review of n=4206 patients with SCAD, beta-blockers were found to be significantly associated with a reduced risk of SCAD recurrence after adjustment for confounders; RR of 0.51 (95% CI 0.33 -0.77, P=0.0013).

• #31 Spontaneous Coronary Artery Dissection: An Elusive Disease of the Coronaries | Methodist DeBakey Cardiovascular J

  https://journal.houstonmethodist.org/articles/10.14797/mdcvj.1129

  Risk factors include female gender, pregnancy, fibromuscular dysplasia connective tissue disorders, hormonal therapies, corticosteroids, and emotional and physical stressors. Traditional risk factors of MI are generally few or absent. […] Chest pain, the most common presentation of SCAD, rarely presents with cardiogenic shock, ventricular arrythmias, and sudden cardiac death. […] Diagnosis of SCAD is generally made on coronary angiography. Based on its angiographic appearance, it has three types of Yip-Saw classification: (1) multiple radiolucent lumens or arterial wall contrast staining; (2) presence of diffuse stenosis of varying severity and length (most commonly seen); and (3) focal or tubular stenosis mimics atherosclerosis. […] While optimal management is up for debate, conservative medical therapy is recommended in most cases. Healing of SCAD lesion occurs in a majority of patients (70-97%) after conservative management, but recurrence is common.

• #32 Management of SCAD | Spontaneous Coronary Artery Dissection (SCAD)

  https://scad.ubc.ca/management-of-scad/

  The long-term prognosis for SCAD survivors after their initial SCAD presentation is good. Recurrent SCAD events, however, are frequent and these patients must be followed closely. Conservative medical management for stable patients with resolved ischemia is typical. Revascularization via percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) may be necessary for a small percentage of patients. […] Medical management of SCAD deviates from standard ACS therapy. In particular, thrombolytic therapy should be avoided for patients with SCAD. Therefore, early coronary angiography to establish SCAD is important. […] Beta-blockers offer benefits in aortic dissection by reducing arterial wall shear stress. Extrapolating these benefits, we routinely administer beta-blockers for SCAD, both acutely and long-term.

• #33

  https://link.springer.com/article/10.1007/s11886-023-02019-w

  To date, most data on SCAD is retrospective, with only a few cohort studies available to support currently accepted conservative management. Little data exists to provide insight into diagnostic strategies or optimal management for patients with unstable, recurrent, or multivessel SCAD. […] Acute management of SCAD is focused on maintaining myocardial perfusion distal to the lesion site. The use of thrombolytic therapy has been reported to adverse events due to IMH extension and therefore is not recommended. […] Although no randomized control studies for the management of SCAD exist, recent cohort studies support conservative management when feasible. […] Medical therapy for SCAD initially begins with standard therapy for ACS including anticoagulation and antiplatelet therapy. […] The mainstay of medical treatment after SCAD diagnosis includes guideline therapy for patients with reduced ejection fraction when warranted. Beta-blocker therapy may be also warranted if ventricular ectopy occurs.

• #34 Spontaneous Coronary Artery Dissection: An Elusive Disease of the Coronaries | Methodist DeBakey Cardiovascular J

  https://journal.houstonmethodist.org/articles/10.14797/mdcvj.1129

  Revascularization with percutaneous coronary intervention or coronary artery bypass graft surgery should be considered in patients with symptoms of ongoing ischemia, hemodynamic instability, or left main dissection and/or involvement of the proximal part of the epicardial vessels. […] Long-term medical therapy includes aspirin and beta blockers. Beta blocker use has been associated with lower risk of recurrent SCAD. The role of antiplatelets, like clopidogrel, remains unclear but is used commonly in contemporary clinical practice.

• #35 Management of SCAD | Spontaneous Coronary Artery Dissection (SCAD)

  https://scad.ubc.ca/management-of-scad/

  The long-term prognosis for SCAD survivors after their initial SCAD presentation is good. Recurrent SCAD events, however, are frequent and these patients must be followed closely. Conservative medical management for stable patients with resolved ischemia is typical. Revascularization via percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) may be necessary for a small percentage of patients. […] Medical management of SCAD deviates from standard ACS therapy. In particular, thrombolytic therapy should be avoided for patients with SCAD. Therefore, early coronary angiography to establish SCAD is important. […] Beta-blockers offer benefits in aortic dissection by reducing arterial wall shear stress. Extrapolating these benefits, we routinely administer beta-blockers for SCAD, both acutely and long-term.

• #36

  https://link.springer.com/article/10.1007/s11886-023-02019-w

  To date, most data on SCAD is retrospective, with only a few cohort studies available to support currently accepted conservative management. Little data exists to provide insight into diagnostic strategies or optimal management for patients with unstable, recurrent, or multivessel SCAD. […] Acute management of SCAD is focused on maintaining myocardial perfusion distal to the lesion site. The use of thrombolytic therapy has been reported to adverse events due to IMH extension and therefore is not recommended. […] Although no randomized control studies for the management of SCAD exist, recent cohort studies support conservative management when feasible. […] Medical therapy for SCAD initially begins with standard therapy for ACS including anticoagulation and antiplatelet therapy. […] The mainstay of medical treatment after SCAD diagnosis includes guideline therapy for patients with reduced ejection fraction when warranted. Beta-blocker therapy may be also warranted if ventricular ectopy occurs.

• #37 Management of SCAD | Spontaneous Coronary Artery Dissection (SCAD)

  https://scad.ubc.ca/management-of-scad/

  The choice to revascularize a dissected artery depends on both the affected coronary anatomy and the patients clinical status. Conservative treatment is preferred for most stable patients without ongoing pain. However, patients with ongoing chest pain, ischemia, ST elevation, or hemodynamic instability should undergo PCI, especially when the dissection affects major arteries with sizable myocardial jeopardy. […] The natural history of the dissected segments is such that the vast majority heals spontaneously, and patients appear to have good long-term outcome if they survive their initial event. We recommend reserving PCI for patients with ongoing chest pain and ischemia when the lesion is amenable to stenting, and to consider CABG for extensive dissections involving the left main.

• #38 Spontaneous Coronary Artery Dissection (SCAD) – REBEL EM – Emergency Medicine Blog

  https://rebelem.com/spontaneous-coronary-artery-dissection-scad/

  Accurate diagnosis in the acute stages of ACS is paramount as the management and investigation of SCAD is different from other causes of ACS. […] Once SCAD is suspected, angiography remains the first-line diagnostic modality. […] Conservative Management: Mainstay of management in those without high-risk features. […] Majority of patients have angiographic healing of SCAD lesions without intervention. […] SCAD patients with high-risk features: […] High-Risk Features: Left Main Coronary Artery Dissection, Ongoing or Recurrent Ischemia or Chest Pain, Ventricular Tachycardia or Ventricular Fibrillation, Cardiogenic Shock. […] PCI: Due to coronary artery fragility observed in SCAD, PCI is associated with increased risk of complications and variables outcomes. […] CABG: Described for SCAD patients with left main or proximal dissection, those with failure of attempted PCI, and those with refractory ischemia despite conservative approach.

• #39 Spontaneous Coronary Artery Dissection: Current State

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/03/02/11/28/Spontaneous-Coronary-Artery-Dissection-Current-State

  Coronary angiography is recommended as a first-line diagnostic imaging method for early invasive management of ACS. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can aid the diagnosis, but carry the risk of iatrogenic extension of the dissection. […] Understanding the different appearances, especially the long smooth narrowing type 2 pattern, can help prevent misdiagnosis as coronary vasospasm, normal coronaries, atherosclerotic disease, thromboembolism, or takotsubo syndrome. […] Conservative management should be considered in clinically stable patients without high-risk anatomy. Extended inpatient monitoring for 3-5 days is recommended. In patients with ongoing ischemia, left main artery dissection, or hemodynamic instability, urgent intervention with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) can be considered.

• #40 Spontaneous coronary artery dissection: Principles of management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/11/623

  Spontaneous coronary artery dissection (SCAD) is an acute noniatrogenic tear in the coronary arterial wall, leading to disruption of coronary blood flow and myocardial infarction. […] SCAD is primarily managed medically in clinically stable patients. […] Long-term management includes screening for fibromuscular dysplasia and other arteriopathies, monitoring for recurrence, and cardiac rehabilitation. […] Observational studies have consistently demonstrated that PCI in the setting of SCAD is associated with worse outcomes and high complication rates. […] In a retrospective study of 189 patients with SCAD, the procedural failure rate was 53% in those managed with PCI. […] Patients should therefore be monitored closely for new or worsening cardiac symptoms, which should prompt further testing. […] Cardiac rehabilitation is an important component of management following SCAD, but it remains significantly underused. […] We recommend referring all patients with SCAD for cardiac rehabilitation, including young women without other comorbidities.

• #41 Spontaneous coronary artery dissection

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/spontaneous-coronary-artery-dissection

  Most coronary dissections will heal spontaneously, and conservative treatment is recommended for uncomplicated cases. […] Patients with left main stem involvement, complete vessel occlusion, ongoing chest pain or haemodynamic instability will require coronary revascularisation. […] PCI results are suboptimal in this challenging group of patients. […] PCI should be performed by experienced operators, with the use of intravascular imaging and preferably with on-site surgical backup due to the increased risk of complications. […] Although long-term prognosis is excellent, the risk of recurrent SCAD events is significant, with an average rate of 5% per year.

• #42 Spontaneous Coronary Artery Dissection: Current State

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/03/02/11/28/Spontaneous-Coronary-Artery-Dissection-Current-State

  PCI for treatment of SCAD is associated with an increased risk of complications and technical failure. The risk of iatrogenic dissections and extension of dissections can be reduced by avoiding deep catheter engagement, noncoaxial positioning of catheter tip, catheter dampening, and strong contrast agent injection. […] Interventional PCI strategies include: 1) long drug-eluting stents that cover the 5-10 mm on each edge of dissection; 2) direct stenting without balloon predilation; 3) balloon angioplasty alone; 4) cutting balloon fenestration to decompress the false lumen (perform with caution); 5) multistent approach by sealing distal and proximal ends first; and 6) bioresorbable stents. […] CABG is appropriate for left main and proximal dissections, PCI complications, or ongoing ischemia. One study reported a high rate of venous and arterial conduit failure, likely due to the subsequent healing of the native SCAD vessels causing competitive flow and graft occlusion.

• #43

  https://link.springer.com/article/10.1007/s11886-023-02019-w

  While most cases of SCAD can be successfully managed conservatively, a minority of patients require more aggressive therapy. […] When addressing lesions, interventionalists should maintain a conservative approach. […] Techniques to minimize risk include decompression of the false lumen through fenestration techniques with small-diameter cutting balloon angioplasty, proximal and distal end stenting, along with the use of DES when stenting is warranted. […] Management of SCAD is primarily conservative. Initial management typically involves the use of antiplatelet and anticoagulation due to ACS; however, this should be discontinued after diagnosis of SCAD is established. […] PCI is reserved for patients with hemodynamic compromise or ongoing ischemia despite conservative measures. This is due to the high risk for periprocedural complications associated with PCI in SCAD patients. […] Due to the self-resolving nature of SCAD lesions, proceduralists should perform minimal intervention to achieve acceptable distal flow.

• #44 Spontaneous Coronary Artery Dissection: Current State

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/03/02/11/28/Spontaneous-Coronary-Artery-Dissection-Current-State

  PCI for treatment of SCAD is associated with an increased risk of complications and technical failure. The risk of iatrogenic dissections and extension of dissections can be reduced by avoiding deep catheter engagement, noncoaxial positioning of catheter tip, catheter dampening, and strong contrast agent injection. […] Interventional PCI strategies include: 1) long drug-eluting stents that cover the 5-10 mm on each edge of dissection; 2) direct stenting without balloon predilation; 3) balloon angioplasty alone; 4) cutting balloon fenestration to decompress the false lumen (perform with caution); 5) multistent approach by sealing distal and proximal ends first; and 6) bioresorbable stents. […] CABG is appropriate for left main and proximal dissections, PCI complications, or ongoing ischemia. One study reported a high rate of venous and arterial conduit failure, likely due to the subsequent healing of the native SCAD vessels causing competitive flow and graft occlusion.

• #45 Spontaneous Coronary Artery Dissection (SCAD)

  https://www.tgh.org/institutes-and-services/conditions/spontaneous-coronary-artery-dissection-scad

  If SCAD is not causing a significant arterial blockage and its symptoms are mild or absent, a physician may suggest close monitoring and lifestyle modifications, such as stress reduction, to reduce the risk of further arterial dissections. […] A physician may prescribe antiplatelet agents, beta-blockers or angiotensin-converting enzyme (ACE) inhibitors to help manage symptoms, stabilize blood pressure or reduce the risk of blood clot formation. […] A physician may recommend a tailored program of structured exercise, education and support to improve the patients overall heart health and reduce their cardiovascular risk factors. […] If SCAD is causing a significant arterial blockage, a percutaneous coronary intervention (PCI) or stent placement may be considered to restore blood flow. […] If multiple arteries are affected by SCAD, a CABG procedure may be performed to reroute the flow of blood around the damaged areas.

• #46 Spontaneous coronary artery dissection

  https://www.myamericannurse.com/spontaneous-coronary-artery-dissection/

  Nurses should have a high level of suspicion for spontaneous coronary artery dissection (SCAD) when patients, especially young women, present with chest pain and other acute coronary syndrome symptoms, in the absence of or in the presence of few atherosclerotic risk factors. […] Nurses are uniquely positioned to provide emotional support and education to patients and family members to help them understand SCAD risk factors, signs and symptoms, medications, and for follow-up for long-term monitoring and care. […] All nurses, especially ED nurses, should have a high level of suspicion for SCAD when patients, particularly young women, present with chest pain or other ACS symptoms but have no or few atherosclerotic risk factors. Nurses can help facilitate coronary angiography as early as possible, especially in the case of STEMI.

• #47 Spontaneous coronary artery dissection

  https://www.myamericannurse.com/spontaneous-coronary-artery-dissection/

  Post-SCAD care includes vigilant assessment and monitoring for hemodynamic instability, cardiac arrhythmias, fluid overload, and signs and symptoms of ischemia (for example, chest pain or persistent ST elevation). […] During the immediate postpartum period for women with SCAD, monitor for signs and symptoms of bleeding in patients who receive percutaneous coronary intervention along with antiplatelet therapy and anticoagulation therapy. […] SCAD is a frightening, life-threatening experience for patients and family members. You can provide emotional support and education to help them understand SCAD risk factors, signs and symptoms, medications, and the need for cardiac rehabilitation and follow-up medical monitoring and care.

• #48 Spontaneous coronary artery dissection

  https://www.myamericannurse.com/spontaneous-coronary-artery-dissection/

  Post-SCAD care includes vigilant assessment and monitoring for hemodynamic instability, cardiac arrhythmias, fluid overload, and signs and symptoms of ischemia (for example, chest pain or persistent ST elevation). […] During the immediate postpartum period for women with SCAD, monitor for signs and symptoms of bleeding in patients who receive percutaneous coronary intervention along with antiplatelet therapy and anticoagulation therapy. […] SCAD is a frightening, life-threatening experience for patients and family members. You can provide emotional support and education to help them understand SCAD risk factors, signs and symptoms, medications, and the need for cardiac rehabilitation and follow-up medical monitoring and care.

• #49 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  Women who have spontaneous coronary artery dissection and who would like to become pregnant should receive preconception counseling as SCAD tends to recur and can present with severe complications during pregnancy. […] Managing patients with acute spontaneous coronary artery dissection requires an interprofessional team of clinicians (MDs, DOs, NPs, and PAs), specialists, nursing staff, and ancillary staff, working collaboratively and communicating case details between various disciplines.

• #50 Spontaneous coronary artery dissection

  https://www.myamericannurse.com/spontaneous-coronary-artery-dissection/

  Post-SCAD care includes vigilant assessment and monitoring for hemodynamic instability, cardiac arrhythmias, fluid overload, and signs and symptoms of ischemia (for example, chest pain or persistent ST elevation). […] During the immediate postpartum period for women with SCAD, monitor for signs and symptoms of bleeding in patients who receive percutaneous coronary intervention along with antiplatelet therapy and anticoagulation therapy. […] SCAD is a frightening, life-threatening experience for patients and family members. You can provide emotional support and education to help them understand SCAD risk factors, signs and symptoms, medications, and the need for cardiac rehabilitation and follow-up medical monitoring and care.

• #51 Spontaneous Coronary Artery Dissection Across the Health Care Pathway: A National, Multicenter, Patient‐Informed Investigation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10863752/

  Clinical practice guidelines for the management and convalescence of patients with spontaneous coronary artery dissection (SCAD) have yet to be developed. […] The awareness and detection of SCAD as a cardiac event was low among patients (35%) and perceived to be moderate among health care providers (55%). […] Health care providers’ communication of the prognosis and self-management of SCAD were perceived to be poor (79%). […] Short and longer-term follow-up that was tailored to patients’ needs was desired (72%). […] Conventional cardiac rehabilitation and other secondary prevention programming, including informational and psychosocial interventions, are recommended but are not currently meeting the perceived unique needs of patients with SCAD. […] The results from this study provide context for clinical practice guidelines that are grounded in patient experience and will support the development of relevant and impactful interventions at several points on the trajectory of patients with SCAD.

• #52 Psychosocial impacts of spontaneous coronary artery dissection: A qualitative study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0273978

  Participants reported a range of emotional impacts of SCAD. […] Participants described a range of difficulties regarding self-management of their condition, again often linked to inadequate or conflicting information. […] Several participants were dealing with concerns related to family members, including their potential risk of SCAD, emotional impacts, difficulties managing family responsibilities, and over-protectiveness of family members. […] SCAD impacted negatively on work in a variety of ways. […] As noted, a lack of information was an over-arching theme that permeated all discussions and impacted on all other areas. […] The intense emotional impacts of SCAD could be ameliorated through improved provision of information and coherent collaborative care from the healthcare system. […] The findings point to the urgent need for provision of psychosocial support for SCAD survivors.

• #53 Spontaneous coronary artery dissection: Principles of management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/11/623

  Spontaneous coronary artery dissection (SCAD) is an acute noniatrogenic tear in the coronary arterial wall, leading to disruption of coronary blood flow and myocardial infarction. […] SCAD is primarily managed medically in clinically stable patients. […] Long-term management includes screening for fibromuscular dysplasia and other arteriopathies, monitoring for recurrence, and cardiac rehabilitation. […] Observational studies have consistently demonstrated that PCI in the setting of SCAD is associated with worse outcomes and high complication rates. […] In a retrospective study of 189 patients with SCAD, the procedural failure rate was 53% in those managed with PCI. […] Patients should therefore be monitored closely for new or worsening cardiac symptoms, which should prompt further testing. […] Cardiac rehabilitation is an important component of management following SCAD, but it remains significantly underused. […] We recommend referring all patients with SCAD for cardiac rehabilitation, including young women without other comorbidities.

• #54 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  SCAD is one of the most common causes of MI in pregnant women with the post-partum period the most at-risk period. […] FMD screening has been advocated for in all patients with SCAD. […] It is recommended that all patients with SCAD following an ACS should be referred to cardiac rehabilitation. […] Psychological disorders, including depression, anxiety, and post-traumatic stress disorder, are highly prevalent among patients with SCAD, especially in the first year after presentation. […] Genetic screening of all people with SCAD is generally low yield and therefore not routinely recommended. […] The development of SCAD registries around the world has allowed significant progress in our understanding of this condition. […] Current data suggests that most patients with SCAD can be managed conservatively without intervention and that beta-blockers are associated with a lower risk of recurrence.

• #55 Spontaneous Coronary Artery Dissection: Current State

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/03/02/11/28/Spontaneous-Coronary-Artery-Dissection-Current-State

  Systemic anticoagulation with heparin should be avoided after the diagnosis of SCAD. Dual antiplatelet therapy is recommended after PCI. In patients managed medically, most experts recommend aspirin for at least a year, and some also recommend clopidogrel for a few months to a year. […] Recurrent chest pain is common, even in the absence of recurrent ischemia. Chest pain sometimes occurs at predictable times of the menstrual cycle, possibly related to endothelial and microvascular dysfunction. This pain may be responsive to long-acting nitrates or calcium channel blockers. […] Pregnancy after SCAD should be managed by a multidisciplinary team. Careful planning for labor and delivery is important, but vaginal delivery is generally recommended. […] Cardiac rehabilitation is important for SCAD survivors. Severe restrictions in activity and weight lifting are not necessary, but extreme high-intensity exercise should be avoided.

• #56 Spontaneous coronary artery dissection (SCAD) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/spontaneous-coronary-artery-dissection/diagnosis-treatment/drc-20353716

  After treatment for SCAD, you need regular checkups with your health care team. […] A personalized program of exercise and education may be suggested. This is called cardiac rehabilitation, also known as cardiac rehab. It’s created to help you recover from a serious heart condition. […] If you’ve had SCAD, talk to a health care professional before becoming pregnant. Pregnancy may not be safe after having SCAD. […] Don’t hesitate to ask other questions you have.

• #57 Spontaneous Coronary Artery Dissection (SCAD) | Treatment & Diagnosis | UH Harrington Heart & Vascular Institute | University Hospitals | Cleveland, Ohio | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/spontaneous-coronary-artery-dissection

  If you are treated for SCAD, you’ll require follow-up appointments with your doctor to monitor for any changes in your condition, including the development of any new tears in your arteries. Your doctor may also recommend other types of care to help you recover and to prevent other health problems. Continuing care measures may include: Cardiac rehabilitation is a tailored program of education and exercise designed to help you recover from a serious heart condition.

• #58 Spontaneous Coronary Artery Dissection (SCAD)

  https://www.tgh.org/institutes-and-services/conditions/spontaneous-coronary-artery-dissection-scad

  SCAD patients typically require ongoing follow-up so their physician can continually assess their heart health and the status of their coronary arteries and adjust their treatment plan as needed. […] Given the rarity and complexity of SCAD, it is important to seek care from a specialist who has expertise in diagnosing and treating it.

• #59 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  Women who have spontaneous coronary artery dissection and who would like to become pregnant should receive preconception counseling as SCAD tends to recur and can present with severe complications during pregnancy. […] Managing patients with acute spontaneous coronary artery dissection requires an interprofessional team of clinicians (MDs, DOs, NPs, and PAs), specialists, nursing staff, and ancillary staff, working collaboratively and communicating case details between various disciplines.

• #60 Spontaneous Coronary Artery Dissection (SCAD)

  https://www.massgeneral.org/heart-center/treatments-and-services/womens-heart-health/spontaneous-coronary-artery-dissection

  Spontaneous coronary artery dissection (SCAD) is a rare condition requiring specialized diagnosis and treatment. […] Spontaneous coronary artery dissection (SCAD) is a rare condition that occurs when a tear forms in one or more blood vessels of the heart, which can slow or block blood flow to the heart and cause a heart attack. […] Although SCAD may seem similar to other conditions that cause heart attacks, it is a unique disorder that should be managed and monitored by specialists with expertise in the disease. […] At the Elizabeth Anne and Karen Barlow Corrigan Womens Heart Health Program in the Massachusetts General Hospital Corrigan Minehan Heart Center, a multidisciplinary team that includes experts in cardiology, vascular medicine and genetics works together to conduct a comprehensive evaluation in order to develop a treatment plan that is personalized to each patient’s particular condition.

• #61 Spontaneous coronary artery dissection: from expert consensus statements to evidence-based medicine – Alfonso – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/22447/html

  Management of pregnancy-related SCAD is particularly challenging. […] A multidisciplinary approach is recommended for these patients. […] Overall, general recommendations are similar and conservative medical management is also preferred. […] Cardiac rehabilitation is also addressed in great detail in the AHA scientific statement. […] Current evidence suggests low referral of these patients to rehabilitation programs despite emerging evidence supporting its benefits in this particular setting. […] Physiological considerations are also very important. These young patients frequently develop anxiety or depression when faced with the uncertainties on their diagnosis, treatment and prognosis.

• #62 Spontaneous Coronary Artery Dissection: Current State

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2018/03/02/11/28/Spontaneous-Coronary-Artery-Dissection-Current-State

  Systemic anticoagulation with heparin should be avoided after the diagnosis of SCAD. Dual antiplatelet therapy is recommended after PCI. In patients managed medically, most experts recommend aspirin for at least a year, and some also recommend clopidogrel for a few months to a year. […] Recurrent chest pain is common, even in the absence of recurrent ischemia. Chest pain sometimes occurs at predictable times of the menstrual cycle, possibly related to endothelial and microvascular dysfunction. This pain may be responsive to long-acting nitrates or calcium channel blockers. […] Pregnancy after SCAD should be managed by a multidisciplinary team. Careful planning for labor and delivery is important, but vaginal delivery is generally recommended. […] Cardiac rehabilitation is important for SCAD survivors. Severe restrictions in activity and weight lifting are not necessary, but extreme high-intensity exercise should be avoided.

• #63 Spontaneous Coronary Artery Dissection | Norton Healthcare

  https://nortonhealthcare.com/services-and-conditions/heart-and-vascular-care/programs/heart-disease-in-women/spontaneous-coronary-artery-dissection/

  Heart attacks during pregnancy or shortly after are rare. When they do happen, a common cause is spontaneous coronary artery dissection. In fact, spontaneous coronary artery dissection is the most common cause of pregnancy-associated heart attack. […] Spontaneous coronary artery dissection is a tear in the layers of an artery’s wall. Blood flows under the tear, often making it larger, and pools there. As the area fills with blood, it expands and blocks blood flow. […] At the Norton Heart & Vascular Institute Women’s Heart Program, our board-certified and fellowship-trained cardio-obstetrics specialists focus on heart conditions that are more prevalent among women, especially around pregnancy and menopause. […] Women’s Heart Program providers work with your health care team, including your OB/GYN and maternal-fetal medicine specialist, to create a comprehensive care plan.

• #64 Spontaneous Coronary Artery Dissection Across the Health Care Pathway: A National, Multicenter, Patient‐Informed Investigation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10863752/

  Clinical practice guidelines for the management and convalescence of patients with spontaneous coronary artery dissection (SCAD) have yet to be developed. […] The awareness and detection of SCAD as a cardiac event was low among patients (35%) and perceived to be moderate among health care providers (55%). […] Health care providers’ communication of the prognosis and self-management of SCAD were perceived to be poor (79%). […] Short and longer-term follow-up that was tailored to patients’ needs was desired (72%). […] Conventional cardiac rehabilitation and other secondary prevention programming, including informational and psychosocial interventions, are recommended but are not currently meeting the perceived unique needs of patients with SCAD. […] The results from this study provide context for clinical practice guidelines that are grounded in patient experience and will support the development of relevant and impactful interventions at several points on the trajectory of patients with SCAD.

• #65 Psychosocial impacts of spontaneous coronary artery dissection: A qualitative study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0273978

  Spontaneous coronary artery dissection (SCAD) is an increasingly recognised cause of acute myocardial infarction, particularly in younger women without classic cardiac risk factors. […] Emerging evidence suggests that SCAD is a particularly stressful event, with high rates of anxiety and depression reported in quantitative studies. […] It has been postulated that SCAD is a particularly stressful event due to its rarity, sudden onset, unclear pathogenesis, uncertain optimal acute and long-term management, and likelihood of recurrence. […] The present study used a qualitative approach to investigate the experiences of SCAD survivors, with a focus on the psychosocial impacts of SCAD. […] The major and overarching theme that emerged was lack of information about SCAD, including information related to its cause, management and prognosis.

• #66 Psychosocial impacts of spontaneous coronary artery dissection: A qualitative study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0273978

  Participants reported a range of emotional impacts of SCAD. […] Participants described a range of difficulties regarding self-management of their condition, again often linked to inadequate or conflicting information. […] Several participants were dealing with concerns related to family members, including their potential risk of SCAD, emotional impacts, difficulties managing family responsibilities, and over-protectiveness of family members. […] SCAD impacted negatively on work in a variety of ways. […] As noted, a lack of information was an over-arching theme that permeated all discussions and impacted on all other areas. […] The intense emotional impacts of SCAD could be ameliorated through improved provision of information and coherent collaborative care from the healthcare system. […] The findings point to the urgent need for provision of psychosocial support for SCAD survivors.

• #67 Spontaneous Coronary Artery Dissection Across the Health Care Pathway: A National, Multicenter, Patient‐Informed Investigation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10863752/

  Patients desired a focus on anxiety and stress reduction in addition to physical health behavior modification in cardiac rehabilitation. […] The results provide a detailed description of SCAD across the health care pathway, grounded in patients’ experiences. […] Taken together, our research has important implications for the identification, and acute and long-term management of patients with SCAD.

• #68 Coronary Artery Dissection: Not Just a Heart Attack | American Heart Association

  https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks/coronary-artery-dissection-not-just-a-heart-attack

  They should also make sure they’re reducing other risks for heart disease by: Staying physically active, Reaching a healthy weight, Following a heart healthy-diet, Reducing their sodium intake, Limiting their alcohol intake, Quitting smoking, Managing other conditions such as diabetes, high blood pressure or high cholesterol.

• #69 Spontaneous coronary artery dissection (SCAD) | Heart and Stroke Foundation

  https://www.heartandstroke.ca/heart-disease/conditions/spontaneous-coronary-artery-dissection

  Spontaneous Coronary Artery Dissection (SCAD) is a tear in an artery wall in your heart that allows blood to build up in the space between the layers of your artery wall. This leads to a reduction or blockage of blood flow to your heart, which causes damage to your heart muscle and affects your heart rhythm. Reduced blood flow could cause a heart attack or cardiac arrest (cardiopulmonary arrest). […] Managing SCAD will depend on the location and length of your tear and the damage done to your artery, with the hope that your artery will heal itself. SCAD treatment is usually conservative because surgery and aggressive treatments can be high risk. Treatment options may include: controlling blood pressure, beta-blockers, ACE inhibitors, ASA (aspirin), cardiac rehabilitation. […] Lifestyle changes that may prevent SCAD from recurring include: avoiding emotional stress, regular exercise, without intense weight lifting or competitive sports, achieving a healthy weight and diet to manage blood pressure, pregnancy might be discouraged because of the risk of peripartum SCAD or P-SCAD, cardiac rehabilitation.

• #70 What we know about Spontaneous Coronary Artery Dissection (SCAD) | OHSU

  https://www.ohsu.edu/womens-health/womens-heart-health-leading-cause-heart-attacks-young-women

  Typical lifestyle recommendations for heart disease can help with healing, says Dr. McGrath, Everyone who has experienced SCAD should participate in cardiac rehab to learn ways of exercising safely, avoid very heavy lifting and high intensity exercise, and follow their doctors recommendations for medications to use or avoid. […] Dr. McGrath adds, Patients can also benefit from eating a heart-healthy diet, making sure their blood pressure is well-controlled, and doing regular, low-moderate intensity physical activity after completing cardiac rehab.

• #71 Spontaneous coronary artery dissection (SCAD) | Heart and Stroke Foundation

  https://www.heartandstroke.ca/heart-disease/conditions/spontaneous-coronary-artery-dissection

  It’s normal to feel worried or afraid after a diagnosis of heart disease. Find someone you can turn to for emotional support like a family member, friend, doctor, mental health worker or support group. Talking about your challenges and feelings could be an important part of your journey to recovery.

• #72 Spontaneous coronary artery dissection – BHF

  https://www.bhf.org.uk/informationsupport/conditions/spontaneous-coronary-artery-dissection

  Cardiac rehab is a mix of exercising in a safe space, education, relaxation and psychological support. It aims to help you recover and get back to living your life as fully as possible. […] It’s important to talk about these feelings, either to a trusted loved one, your GP, a cardiac rehab nurse, a clinical psychologist or counsellor.

• #73 About SCAD – SCAD Research Inc

  https://scadresearch.com.au/about-scad/

  Your doctor may also suggest alternate types of care to help with your recovery. […] If you suffer from migraines, which are commonly associated with SCAD, the use of triptans as drugs to treat migraine should be avoided. […] Experiencing a SCAD heart attack can be an extremely unexpected and frightening event as it often affects people who have very few or no risk factors for heart disease. It can be traumatic for the sufferer and their families. The good news is that the prognosis for those treated in a hospital is excellent and generally the tear in the coronary artery heals within 35 days. […] It is perfectly normal to need time to accept what has happened to you and to come to terms with changes in your everyday life. In fact, anxiety or depression after a cardiac event is so common that it even has a name – post cardiac or situational depression, which may even mimic post-traumatic stress disorder – the good news is that it’s common, treatable and often temporary.

• #74 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndromes (ACS), with a higher incidence in younger female patients. […] Despite an exponential rise in the volume of SCAD-focused research and publications within the past decade, SCAD is still a poorly understood condition, with a paucity of randomised controlled trial data. This review discusses the pathophysiology, clinical presentation, diagnosis and management of SCAD alongside areas for future research. […] SCAD is typically characterised by the sudden formation of an intramural haematoma between any of the three layers (intima, media, and adventitia) of the coronary artery wall, forming a false lumen. […] Invasive coronary angiography (ICA) is the current gold-standard investigation to diagnose SCAD.

• #75 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  SCAD is one of the most common causes of MI in pregnant women with the post-partum period the most at-risk period. […] FMD screening has been advocated for in all patients with SCAD. […] It is recommended that all patients with SCAD following an ACS should be referred to cardiac rehabilitation. […] Psychological disorders, including depression, anxiety, and post-traumatic stress disorder, are highly prevalent among patients with SCAD, especially in the first year after presentation. […] Genetic screening of all people with SCAD is generally low yield and therefore not routinely recommended. […] The development of SCAD registries around the world has allowed significant progress in our understanding of this condition. […] Current data suggests that most patients with SCAD can be managed conservatively without intervention and that beta-blockers are associated with a lower risk of recurrence.

• #76 International Spontaneous Coronary Artery Dissection (SCAD)

  https://www.mountsinai.org/clinical-trials/international-spontaneous-coronary-artery-dissection-iscad-registry-scad

  The aim of „iSCAD,” the International Spontaneous Coronary Artery Dissection (SCAD) Registry, is to serve as an internationally collaborative, multicenter registry coordinated by an experienced and centralized coordinating center in an effort to increase the pace of participant recruitment, and thereby increase statistical power of studies related to SCAD. The ultimate goal of iSCAD Registry is to facilitate the development of best practices and clinical guidelines for preventing SCAD or its recurrence. This observational study will be prospective and retrospective in its recruitment and will collect clinical information to better understand the natural history and prognosis for SCAD. […] Inclusion Criteria: Participants with a new diagnosis of SCAD or a history of confirmed or suspected SCAD will be prospectively recruited from either: 1. Inpatient wards of the enrolling medical centers during the acute presentation of SCAD, or 2. Outpatient cardiovascular clinics of enrolling medical centers. Participants must be: – 18 years of age or older – Diagnosis of SCAD or history of SCAD based on coronary angiography, either catheter-based or coronary CTA – Suspected SCAD by coronary angiography. […] Exclusion Criteria: 1. Coronary dissection in association with atherosclerosis or as a result of iatrogenic injury 2. Inability to provide informed consent 3. Inability to complete study-related patient questionnaires 4. Inability to understand and complete patient questionnaires independently.

• #77 Spontaneous Coronary Artery Dissection (SCAD) – Victor Chang Cardiac Research Institute

  https://www.victorchang.edu.au/heart-disease/scad

  It is best to keep your heart healthy and follow advice regarding general heart disease prevention, such as: […] SCAD is responsible for approximately 25% of heart attacks in women under the age of 50. It is the most common cause of heart attack associated with pregnancy. […] The Victor Chang Cardiac Research Institute is leading Australia’s first research program into Spontaneous Coronary Artery Dissection (SCAD). […] Together with Dr Barbara Murphy and Prof Alun Jackson from the Australian Centre for Heart Health, we are investigating the psychosocial consequences of SCAD. […] If you are an Australian SCAD survivor and would like to be involved in the Australian-first research program at the Victor Chang Institute, please email [email protected].

• #78 Spontaneous coronary artery dissection: a clinically oriented narrative review | npj Cardiovascular Health

  https://www.nature.com/articles/s44325-024-00004-y

  SCAD is one of the most common causes of MI in pregnant women with the post-partum period the most at-risk period. […] FMD screening has been advocated for in all patients with SCAD. […] It is recommended that all patients with SCAD following an ACS should be referred to cardiac rehabilitation. […] Psychological disorders, including depression, anxiety, and post-traumatic stress disorder, are highly prevalent among patients with SCAD, especially in the first year after presentation. […] Genetic screening of all people with SCAD is generally low yield and therefore not routinely recommended. […] The development of SCAD registries around the world has allowed significant progress in our understanding of this condition. […] Current data suggests that most patients with SCAD can be managed conservatively without intervention and that beta-blockers are associated with a lower risk of recurrence.

• #79 Spontaneous coronary artery dissection

  https://www.myamericannurse.com/spontaneous-coronary-artery-dissection/

  Nurses should have a high level of suspicion for spontaneous coronary artery dissection (SCAD) when patients, especially young women, present with chest pain and other acute coronary syndrome symptoms, in the absence of or in the presence of few atherosclerotic risk factors. […] Nurses are uniquely positioned to provide emotional support and education to patients and family members to help them understand SCAD risk factors, signs and symptoms, medications, and for follow-up for long-term monitoring and care. […] All nurses, especially ED nurses, should have a high level of suspicion for SCAD when patients, particularly young women, present with chest pain or other ACS symptoms but have no or few atherosclerotic risk factors. Nurses can help facilitate coronary angiography as early as possible, especially in the case of STEMI.

• #80 Spontaneous coronary artery dissection

  https://www.myamericannurse.com/spontaneous-coronary-artery-dissection/

  Post-SCAD care includes vigilant assessment and monitoring for hemodynamic instability, cardiac arrhythmias, fluid overload, and signs and symptoms of ischemia (for example, chest pain or persistent ST elevation). […] During the immediate postpartum period for women with SCAD, monitor for signs and symptoms of bleeding in patients who receive percutaneous coronary intervention along with antiplatelet therapy and anticoagulation therapy. […] SCAD is a frightening, life-threatening experience for patients and family members. You can provide emotional support and education to help them understand SCAD risk factors, signs and symptoms, medications, and the need for cardiac rehabilitation and follow-up medical monitoring and care.

• #81 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  Women who have spontaneous coronary artery dissection and who would like to become pregnant should receive preconception counseling as SCAD tends to recur and can present with severe complications during pregnancy. […] Managing patients with acute spontaneous coronary artery dissection requires an interprofessional team of clinicians (MDs, DOs, NPs, and PAs), specialists, nursing staff, and ancillary staff, working collaboratively and communicating case details between various disciplines.

• #82 Spontaneous Coronary Artery Dissection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK582143/

  Women who have spontaneous coronary artery dissection and who would like to become pregnant should receive preconception counseling as SCAD tends to recur and can present with severe complications during pregnancy. […] Managing patients with acute spontaneous coronary artery dissection requires an interprofessional team of clinicians (MDs, DOs, NPs, and PAs), specialists, nursing staff, and ancillary staff, working collaboratively and communicating case details between various disciplines.

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