Spontaneous coronary artery dissection (SCAD)

Spontaneous coronary artery dissection (SCAD) is a rare disease with a female preponderance and tendency to occur in pregnancy, making a hormonal influence likely. 
 

According to a study (J Invasive Cardiol 2008; 20:553–9), only 500 cases of SCAD have been documented in the medical literature till no, and it may be due to a significant number of SCAD patients dying suddenly. 

In a recent issue of ARYA Atherosclerosis, I have reported a case of SCAD in an aged male who presented with SCAD and was managed successfully by PCI and stenting. 

http://www.arya.mui.ac.ir/index.php/arya/article/view/650

This is a very nice paper, not only because this is the first reported case from Nepal, but also because SCAD was detected in a 69-year old male who presented with unstable angina. SCAD has been reported most commonly in young women of whom approx 30% of cases occur in peripartum period. It may be secondary to decreased collagen production or enhanced degradation in intima and media of vessel wall, increased shear stress on arterial wall due to augmented cardiac output, inherent hypercoagulability in peripartum state, and hemorrhagic disruption of vasa vasorum. 

[Full text article can be downloaded soon from the Journal website]

Since there are no guidelines regarding optimal treatment of this condition, management of SCAD remains controversial.

Our patient was managed with PCI and stenting and he is doing well with no angina at 6-month follow-up.

SCAD (Radiolucent dissection (arrows)) in LCX. Circ 2012;126:579-588 

SCAD in RCA. Dubey L. ARYA Atheroscler 2014 Vol 10 No 2 

Note:

Incidence of SCAD is very low. SCAD occurs most often in young women (age <40 years). It occurs frequently in the peripartum period. However, there are a few reports (including my case report) SCAD can be seen in the middle or older aged males with risk factor for CAD.