The document discusses spontaneous coronary artery dissection (SCAD), noting its low incidence but highlighting that it predominantly affects women, especially during the peripartum period. It outlines the natural history and survival rates of SCAD, with better outcomes in pregnant women and emphasizes the risk of recurrent dissections. Treatment is individualized, suggesting a combination of medical therapy and close follow-up for patients with symptoms of ischemia.

1. Dr Ramachandra

2. What does it mean?

3. Introduction
• Pretty H(1931)-1st
reported case
• CAG : 0.2% incidence
• Mean age :40 yrs
• Men:30%,female:70%(peripartum)
• LAD(y) in ladies : most commonly

4. Key pathology
Predisposition
Intimal rupture
double lumen
Bleeding into vasa vasorum
intramural hematoma
abrupt vessel closure

5. Risk is not clear
remains unclear
CAD/ peripartum: most
common
 hypertension
 CTD:Marfan’s syndrome, EDS,
vasculitis:PAN,SLE, eosinophilic
arteritis, APS, and IBD

6. Natural history
• Survival rates of SCAD is 70-90% survival
• Outcomes being more favourable should the
acute phase be survived
• 1- and 10- year mortality 1.1% and 7.7%
• Men tend to have better survival rates
• Peri- or postpartum period have an even
better prognosis than not pregnant

7. Natural history
In a review of 152 cases
Kamineni et al. reported
that 50% of patients
developed recurrent
dissection within two
months.
KamineniR., SadhuA., andAlpert
J.S.: Spontaneouscoronaryarterydissection:
reportoftwocasesanda50-yearreviewofthe
literature. CardiologyinReview. 2002; 10:
pp. 279-284

8. Natural history
Recurrent dissection within
one month of the first event is
more common .High chance of
developing recurrent
dissection if there is a
generalised vessel weakness
as in pregnant SCAD patients,
where more than 40%
demonstrated dissections in
more than one vessel
Koul A.K., Hollander G.,
Moskovits N., Frankel R.,
Herrera L., and Shani J.:
Coronary artery dissection
during pregnancy and the
postpartum period: two case
reports and review of
literature. Catheterization and
Cardiovascular Interventions:
Official Journal of the Society
for Cardiac Angiography &
Interventions. 2001; 52: pp.
88-94

9. Natural history
• Tanis W., St ella P.R., Kirkels J .H., Pij lman A.H., Pet ers R.H., and
de Man F.H.: Spont aneous coronar y art ery dissect ion: current
insight s and t her apy. Net herlands Heart J ournal: Mont hly
J ournal of t he Net her lands Societ y of Cardiology and t he
Net herlands Heart Foundat ion. 2008; 16: pp. 344-349
• Hering D., Piper C., Hohmann C., Schult heiss H.P., and
Horst kot t e D.: [Prospect ive st udy of t he incidence, pat hogenesis
and t herapy of spont aneous, by coronary angiography diagnosed
coronary art ery dissect ion]. Zeit schrif t f ur Kardiologie. 1998;
87: pp. 961-970
• Kamineni R., Sadhu A., and Alpert J .S.: Spont aneous coronary
art ery dissect ion: report of t wo cases and a 50-year review of
t he lit erat ure. Cardiology in Review. 2002; 10: pp. 279-284

10. Must be individualized
Rx like ACS(+UFH)
GP IIB-IIIA/TLT is a either edged
sword-choose it carefully
Angioplasty/surgery to the need
Close F/U must

11. Follow me up
• Progression of the dissection and formation of
pseudoaneurysms
• Any symptoms of recurrent ischemia
• Stress testing with nuclear perfusion imaging
is preferred over coronary angiography as a
means of surveillance

12. Conclusion
• Any young woman
• Nil risk factors for coronary artery disease and
acute myocardial infarction
• Propensity for extension of dissection with or
without mechanical revascularization
• Spontaneous healing
• Medical a is rational
• Therapy must be individualized

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