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Spontaneous coronary artery dissection screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Synonyms and keywords: SCAD

Overview

Overview

SCAD usually is the result of an underlying vascular or connective tissue disorders. In order to provide the best care to patients with SCAD, the scientific statement from the American Heart Association (AHA) recommends a detailed review of systems and personal and family history of SCAD-associated symptoms and conditions. In addition, the AHA statement recommends a complete vascular exam. Routine clinical or genetic screening of asymptomatic relatives of patients with SCAD is not recommended. However, genetic screening is recommended in first-degree family members of patients with SCAD in whom a monogenic vascular disease has been identified.

Screening

Screening

SCAD usually is the result of an underlying vascular or connective tissue disorders. In order to provide the best care to patients with SCAD, the scientific statement from the American Heart Association (AHA) recommends a detailed review of systems and personal and family history of SCAD-associated symptoms and conditions. [1]
In addition, the AHA statement recommends a complete vascular exam with palpation and auscultation of the following arteries:

Screening Questions

The AHA statement recommends a list of questions to rule out SCAD-associated vasculopathy and connective tissue disorders: [1]

 
 
 
 
Screening Questions:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Personal history of the following conditions:

❑ Early-onset hypertension
❑ Stroke or transient ischemic attack
❑ Pulsatile tinnitus
❑ Migraine headaches
❑ Renal infarction
❑ Subarachnoid hemorrhage
❑ Aneurysm (aortic, peripheral, brain)
❑ Dissection (aortic, peripheral)
❑ Rupture of hollow organs (intestinal, bladder, uterine)
❑ Pneumothorax
❑ Tendon or muscle rupture
❑ Joint dislocation
❑ Talipes equinovarus (clubfoot)
❑ Umbilical or inguinal hernia
❑ Scoliosis or pectus deformity
❑ Pregnancy complications (cervical incompetence, hemorrhage, uterine prolapse, hypertension)
❑ Poor wound healing
❑ Ectopia lentis
❑ Myopia
❑ Detached retina, early glaucoma, or early cataracts
❑ Tall stature
❑ Abnormality of cardiac valve (bicuspid aortic valve, mitral valve prolapse)
❑ Systemic inflammatory disease

Family history of the following conditions:

❑ Dissection (coronary, aortic, peripheral)
❑ Inherited arteriopathy or connective tissue disorder (eg, vascular Ehlers-Danlos syndrome, Marfan syndrome, Loeys-Dietz syndrome)
❑ Fibromuscular dysplasia
❑ Aneurysm (aortic, peripheral, brain)
❑ Early stroke, early myocardial infarction, sudden cardiac death

Review of systems (history of any of the following symptoms)
❑ Headaches
❑ Pulsatile tinnitus
❑ Postprandial abdominal pain
❑ Flank pain
❑ Claudication
❑ Easy bruising
❑ Joint hypermobility or laxity
 
 
 
 
The above table adopted from AHA scientific statement [1]

Genetic Screening of Family Members

References

References

  1. ↑ 1.0 1.1 1.2 1.3 Hayes, Sharonne N.; Kim, Esther S.H.; Saw, Jacqueline; Adlam, David; Arslanian-Engoren, Cynthia; Economy, Katherine E.; Ganesh, Santhi K.; Gulati, Rajiv; Lindsay, Mark E.; Mieres, Jennifer H.; Naderi, Sahar; Shah, Svati; Thaler, David E.; Tweet, Marysia S.; Wood, Malissa J. (2018). “Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association”. Circulation. 137 (19). doi:10.1161/CIR.0000000000000564. ISSN 0009-7322.

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