![]() ![]() Extended inpatient monitoring for 3-5 days is recommended. Conservative management should be considered in clinically stable patients without high-risk anatomy.Coronary computed tomography angiography provides lower spatial and temporal resolution than coronary angiography, and negative results must be interpreted with caution.IVUS and OCT can be used to assist in the diagnosis however, there is a risk that these interventions can extend the dissection, cause iatrogenic dissection, and/or occlude the true lumen.Understanding the different appearances, especially the long smooth narrowing type 2 pattern, can help prevent misdiagnosis as coronary vasospasm, normal coronaries, atherosclerotic disease, thromboembolism, or takotsubo syndrome. Type 3: focal or tubular stenosis this can be confused with a typical atherosclerosis pattern.2B is diffuse narrowing from prox/mid segments to the distal artery. Type 1: classic appearance of multiple radiolucent lumens or arterial wall staining.There are several angiographic appearances:.Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can aid the diagnosis, but carry the risk of iatrogenic extension of the dissection. Coronary angiography is recommended as a first-line diagnostic imaging method for early invasive management of ACS.Some patients are discharged prematurely based on their young age and lack of cardiovascular risk factors. ![]() The diagnosis of SCAD must not be missed.Chest pain and elevated cardiac enzymes along with ischemic changes are characteristic of the presenting acute coronary syndrome (ACS). Initial presentation can be severe, with cardiogenic shock in 2-5%, and ventricular arrhythmias or sudden cardiac death in 3-11%.In several cases, the intimal rupture site was not identified. SCAD is thought to be caused by either an intimal tear, which allows blood to enter and generate a false lumen, or a spontaneous hemorrhage arising from the vasa vasorum within the vessel wall.The following are key points to remember from the American Heart Association Scientific Statement on spontaneous coronary artery dissection (SCAD):
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