Spontaneous coronary artery dissection history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A. Arzu Kalayci, M.D. [2]

Synonyms and keywords: SCAD

The hallmark symptom of spontaneous coronary artery dissection (SCAD) is angina pectoris, similar to other acute coronary syndromes, which may radiate to the jaw or left arm. SCAD should be suspected with these symptoms in relatively young women, especially those in postpartum status. However, many patients do not have typical risk factors of coronary artery disease. Patients are typically asymptomatic on follow-up.

Patients presenting with typical symptoms of acute coronary syndromes and the following clinical characteristics may have suspected spontaneous coronary artery dissection (SCAD):

• Physical exertion^[1]
• Emotional stress^[2]
• Women with an average age ranging from 43 to 50 years^[3][4]
• Postpartum status or history of pregnancy^[5]
• History of smoking
• Atherosclerosis
• Cocaine abuse^[6]
• Presence of a Connective tissue disorder: Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome type 4, cystic medial necrosis, alpha-1 antitrypsin deficiency, or polycystic kidney disease^[7]

• Many patients do not have a previous history of cardiovascular disease or other risk factors andSCAD is idiopathic.^[3]

• The symptoms of SCAD mimic other causes of acute coronary syndromes.
• The most common symptom is an acute and severe onset of chest pain (reported in 85-96% of SCAD patients) characterized by:^[8]

^[9][10]

• Radiation to the arm (49.5%) and neck (22.1%)
• Associated with nausea and vomiting (23.4%), diaphoresis (20.9%), dyspnea (19.3%), or back pain (12.2%)
• Atypical features such as ‘pleuritic’ (9%),‘tearing’ (1.0%), and ‘positional’ (1%)

• One-fourth of patients have reported recurrent symptoms before seeking medical care.^[8]
• Patients may present with:^[11]

• Chronic stable angina
• Myocardial infarction^[3]
• STEMI (26% to 87%)
• NSTEMI (13% to 69%)
• Cardiogenic shock (2% to 5%)
• Ventricular arrhythmia or sudden cardiac death (3% to 11%)
• Sudden cardiac death due to dissections in the left main coronary artery.^[12]
• Pericardial tamponade

• Patients are typically asymptomatic on follow up.^[11]