Spontaneous Coronary Artery Dissection commonly known as SCAD, has been described as an unusual emergency condition predominantly affecting female population between the ages 18-50 years old. The women who suffer this condition have in common that they lack cardiovascualr risk factors. The initial presentation in the mayority of the cases is an Acute Coronary Syndrome with ST elevation. There are important studies which have identified a relationship between high estrogen and progesterone levels with SCAD. Futhermore, other studies have establish intense physical exercise as a pricipitating factor in patients who suffer High blood pressure leading to SCAD.The mechanism is in relation with an increase shear force to the arterial walls provoking a dissection.
In regards with the treatment, there are certain controversies which are faced by the interventional cardiologist once the angiography has been done. In many cases they have to decide to treat the dissection by means of PCI or to treat them conservally with medical therapy. If the decision of treatment is by means of PCI it is important to identify the true lumen of the artery with the help of intravascular ultrasound (IVUS) or Optical coherence tomography (OCT).
A 37 year old women presented with sudden chest pain after waking up. She considered herself a heathy patient, physically fit, and with no cardiovascular risk factors. She denied family history of sudden cardiac death and never smoke. After several minutes with ongoing pain she told her husband about the pain which decided to call emergency services. At arrival at ER she continued with more chest pain and an ECG and blood work were done. Her ECG showed sinus rhythem,71 Bpm with inferior negativeT inversion. She also had positive troponins and was sent to cath lab for a cardiac catheterization. The angiographic wiew of the CX showed a dissection in the distal CX. After discussing options with several interventional cardiologist they decided to treat the patient with conventional medical therapy using beta blokers to reduce shear force. This decision was base upon that the affected artery was a small caliber vessel with TIMI grade flow 3.
In Conclusion, SCAD remains a controversial disease which not always PCI is the best option of treatment. In some cases it is better to treat the patient with medical therapy.