Spontaneous coronary artery dissection medical therapy

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Spontaneous Coronary Artery Dissection Microchapters



Historical Perspective




Differentiating Spontaneous coronary artery dissection from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


Diagnostic Approach

History and Symptoms

Physical Examination

Laboratory Findings






Other Imaging Findings

Other Diagnostic Studies


Treatment Approach

Medical Therapy

Percutaneous Coronary Intervention


Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Type 1

Type 2A

Type 2B

Type 3

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A. Arzu Kalayci, M.D. [2]Sara Zand, M.D.[3]

Synonyms and keywords: SCAD


There are no specific guidelines regarding the optimal management of spontaneous coronary artery dissection. Based on the clinical and angiographic scenario, treatment options include conservative medical regimens similar to that for acute coronary syndrome, percutaneous coronary intervention, and/or coronary artery bypass surgery. In the majority of cases, SCAD may be managed successfully with medical treatment alone in the absence of ongoing myocardial ischemia or hemodynamic instability. Initial conservative management typically includes antithrombotic therapy with heparin, aspirin, clopidogrel and glycoprotein IIb/IIIa inhibitors, and antiischemic therapy with beta blockers and nitrates. However, the use of antithrombotic therapy may increase the risk of bleeding in the false lumen causing an expansion of the intramural hematoma, resulting in a decreased flow through the true lumen.Fibrinolytics should be avoided. Calcium channel blockers may offer relief in coronary artery spasm.

Medical Therapy

Beta Blockers

Antiplatelet Therapy

Anticoagulant and Thrombolytic Therapy

Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker


Antianginal Therapy

  • Common adverse effects include symptomatic hypotension and headache.
  • Routine administration of antianginal therapy for either the index SCAD hospitalization or long term is not recommended.[3]


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