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ECG Cases 40 – Approach to Spontaneous Coronary Artery Dissection (SCAD)

ECG Cases

Jesse McLaren on when to consider Spontaneous Coronary Artery Dissection (SCAD), which patients are at risk for reocclusion, and the challenges of diagnosing SCAD in patients who have nonischemic ECGs despite silent occlusion, occlusions perfused by collaterals, or from non-occlusive MI on this ECG Cases.

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Spontaneous coronary artery dissection in women in the generative period: clinical characteristics, treatment, and outcome—a systematic review and meta-analysis

Frontiers in Cardiovascular Medicine

Introduction Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary arterial wall. Results 14 studies with 2,145 females in the generative period with ACS caused by SCAD were analyzed. The most common clinical presentation of ACS was STEMI in 47.4%. 5.1), 37.7% (95% CI: 1.9–73.4)

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Differences in left ventricular myocardial function and infarct size in female patients with ST elevation myocardial infarction and spontaneous coronary artery dissection

Frontiers in Cardiovascular Medicine

Introduction Differences in pathophysiology, clinical presentation, and natural course of ST-elevation myocardial infarction in female patients due to either spontaneous dissection (SCAD-STEMI) or atherothrombotic occlusion (type 1 STEMI) have been discussed. vs. 1.8 ± 5.1%, p  = 0.002). vs. 1.8 ± 5.1%, p  = 0.002).

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Management and outcomes of spontaneous coronary artery dissection: a systematic review of the literature

Frontiers in Cardiovascular Medicine

Background Contemporary management of spontaneous coronary artery dissection (SCAD) is still controversial. Results The systematic review included 13 observational studies evaluating 1,801 patients with SCAD. Results The systematic review included 13 observational studies evaluating 1,801 patients with SCAD. Approximately 48.5%

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Healthy 45-year-old with chest pain: early repolarization, pericarditis or injury?

Dr. Smith's ECG Blog

Here is the post shock ECG: Cardiology was called stat for ischemic VT, query SCAD vs thrombotic occlusion vs coronary vasospasm. Cath lab was activated: There was no coronary artery disease, but there was spontaneous coronary artery dissection (SCAD) of the distal LAD, which was narrowed by 95%, and treated medically.

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Is coronary dissection painful ?

Dr. S. Venkatesan MD

This has important clinical significance , as many successfully lysed STEMI patient might have minimal segments of dissection/deep plaque fissures. , Spontaneous coronary dissection vs Iatrogenic dissection SCAD is a rare , different entity , enjoys a popular space in the patho-physiology of CAD.

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50 yo with V fib has ROSC, then these 2 successive ECGs: what is the infarct artery?

Dr. Smith's ECG Blog

This certainly looks like an anterior STEMI (proximal LAD occlusion), with STE and hyperacute T-waves (HATW) in V2-V6 and I and aVL. How do you explain the anterior STEMI(+)OMI immediately after ROSC evolving into posterior OMI 30 minutes later? This caused a type 2 anterior STEMI.