Protocol

Diagnosis is the greatest challenge in treating spontaneous coronary artery dissection (SCAD).

If emergency medical professionals look beyond the patient’s age and fitness to suspect SCAD, then there is hope for successful treatment. If the medical team sends the patient home with an antacid or treats the blockage as a classic plaque rupture, the end results can be deadly.

Differentiating SCAD from atherosclerosis is difficult on a standard angiogram — particularly if the cardiologist does not suspect SCAD as a possible cause. New imaging techniques such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS) aid in accurate diagnosis because the “true” and “false” channels of pooled blood caused by the dissection are seen, not mistaken for plaque. (Unfortunately, however, OCT and IVUS are not available in all hospitals.)

Why is this visualization so crucial? If the cardiologist perceives the SCAD to be a standard plaque blockage, he or she may try stent placement, which can cause additional tearing in an artery prone to dissect. Alternately, if the cardiologist sees the dissection and pooled blood, the treatment of choice may be medication management, which allows the clot to resorb and the dissection to gradually heal.

Each SCAD patient is unique. As research advances, progress will be made toward standards regarding conservative treatment, stents, and bypass surgery. The SCAD Alliance Scientific Advisory Board is working toward guidelines for accurate diagnosis and care.

The vital role of the Emergency Department in improving outcomes of SCAD.

For more on the importance of symptom recognition and prompt emergency medical care, please read this SCAD Alliance Scientific Advisory Board white paper: http://bit.ly/SCADinED