3. Diagnosing SCAD
Unfortunately, patients with SCAD can be misdiagnosed at first due to the relative rarity of the disease, their young age, and the fact that conventional imaging (i.e., coronary angiography) can sometimes miss SCAD.
To correctly diagnose SCAD, a doctor may review your signs and symptoms and then order tests to evaluate for a heart attack. These tests can include an electrocardiogram to measure the heart’s electrical activity and a blood test to detect levels of the troponin protein, which is released into the bloodstream when the heart muscle is damaged.
If a heart attack is suspected or diagnosed, it is typically confirmed by taking images of your arteries to look for signs of abnormalities. Imaging tests may include a coronary angiogram (CA), intravascular ultrasound (IVUS), optical coherence tomography (OCT), and/or cardiac computerized tomography (CT) angiography. These are described in more detail in this section.
Tests may include:
During a coronary angiogram, doctors inject a special dye into your arteries so they'll show up on imaging tests. To get the dye to your arteries, doctors insert a long, thin tube (catheter) into an artery — usually in your leg or arm — and thread the tube to the arteries in your heart. Once the dye is released, doctors use X-rays to create pictures of the arteries. The X-rays may show abnormalities in an artery that help confirm spontaneous coronary artery dissection (SCAD). A coronary angiogram can also show if the arteries in the heart (coronary arteries) are abnormal and twisted, called tortuous coronary arteries, which can occur in some people with SCAD.
During heart catheterization, a special imaging catheter may be passed into your arteries to create sound-wave pictures (ultrasound). This may be conducted in addition to coronary angiography to help doctors confirm spontaneous coronary artery dissection (SCAD) and plan treatment decisions.
Optical Coherence Tomography
A catheter equipped with a special light may be passed into your arteries to create light-based pictures. Doctors may perform this test after coronary angiography. The images may show abnormalities in an artery that help doctors confirm spontaneous coronary artery dissection (SCAD) and gather information to guide treatment decisions
Cardiac computerized tomography (CT) angiography
During cardiac computerized tomography (CT) angiography, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show abnormalities in your arteries. Cardiac CT angiography may be used in addition to other tests or as a follow-up test to evaluate your condition after spontaneous coronary artery dissection (SCAD).