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When to Suspect SCAD in Patients Presenting With Cardiac Symptoms

When a young woman with few conventional atherosclerotic risk factors presents to the ED with possible cardiac symptoms, clinicians are urged to consider spontaneous coronary artery dissection (SCAD), according to a recent American Heart Association scientific statement.

During a presentation at the recent European Society of Cardiology Congress 2018, researchers noted that SCAD symptoms can be mistaken for common myocardial infarction, including shortness of breath, arm pain, chest pain, nausea, rapid heartbeat, and light headedness. To better understand clinical presentation, investigators are studying 750 patients who presented with SCAD at Canadian and U.S. centers between 2014 and 2018. Researchers have gathered information about patients that could be linked to SCAD. Eighty-nine percent of patients are female, with an average age of 52. Investigators will follow these patients for three years to monitor major adverse cardiovascular events.

The authors already have unveiled some preliminary findings, noting that 49% of patients reported emotional stress prior to SCAD, and 30% reported physical stress (10% lifting more than 50 pounds). Common predisposing conditions include fibromuscular dysplasia, five or more pregnancies, fertility treatment, peripartum, connective tissue disorders, and systemic inflammatory conditions.

Regarding treatment, the authors noted 14% of patients required percutaneous coronary intervention and 1% underwent bypass surgery. However, most others just took medication only. The authors say a key goal of this ongoing research is to determine best treatment practices for SCAD patients.