Skip to main content

Advertisement

SpringerLink
Log in

Imaging of Spontaneous Coronary Artery Dissection and Counseling Patients of Reproductive Age

  • Reproductive Health and Cardiovascular Disease (G Sharma, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

This review highlights issues relevant to women of reproductive age with a history of spontaneous coronary artery dissection (SCAD).

Recent findings

Current topics regarding the care of SCAD patients include multimodality imaging, pregnancy, lactation, SCAD recurrence, reproductive counseling, migraines, cardiac rehabilitation, and mental health. While no single disease-causing gene for SCAD has been discovered, recent genome-wide association studies show promise for future understanding of underlying mechanisms and risk for SCAD.

Summary

Patients with history of SCAD require dedicated, multidisciplinary care, and women of reproductive age necessitate specific discussion regarding pregnancy, contraception, and menses. Imaging to detect fibromuscular dysplasia and other arteriopathies is recommended in all patients. Pregnancy after SCAD is discouraged, although counseling must be tailored. Systemic exogenous hormones have not been shown to definitively increase the risk of SCAD, but nonhormonal treatment approaches are preferred. Triptan therapy should be discouraged in SCAD patients with migraines, and more research is needed to understand the safety of newer agents. Cardiac rehabilitation after SCAD is safe and encouraged. All SCAD survivors should be screened for post-traumatic stress disorder, depression, and anxiety regardless of time from initial event.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, et al. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation. 2018;137(19):e523–57. https://doi.org/10.1161/CIR.0000000000000564. Comprehensive document reviewing etiology, pathophysiology, and practice recommendations.

  2. •• Hayes SN, Tweet MS, Adlam D, Kim ESH, Gulati R, Price JE, et al. Spontaneous coronary artery dissection: JACC state-of-the-art review. Am Coll Cardiol. 2020;76(8):961–84. https://doi.org/10.1016/j.jacc.2020.05.084. This review provides clinical update on the diagnosis and management of patients with SCAD, including pregnancy-associated SCAD and pregnancy after SCAD, and highlights high priority knowledge gaps that must be addressed.

  3. •• Adlam D, Alfonso F, Maas A, Vrints C, Writing Committee. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a Position Paper on Spontaneous Coronary Artery Dissection. Eur Heart J. 2018;39(36):3353–68. https://doi.org/10.1093/eurheartj/ehy080. Comprehensive document reviewing etiology, pathophysiology, and practice recommendations.

  4. Saw J, Mancini GB, Humphries K, Fung A, Boone R, Starovoytov A, et al. Angiographic appearance of spontaneous coronary artery dissection with intramural hematoma proven on intracoronary imaging. Catheter Cardiovasc Interv. 2016;87(2):E54–61. https://doi.org/10.1002/ccd.26022.

    Article  PubMed  Google Scholar 

  5. Saw J. Coronary angiogram classification of spontaneous coronary artery dissection. Catheter Cardiovasc Interv. 2014;84(7):1115–22. https://doi.org/10.1002/ccd.25293.

    Article  PubMed  Google Scholar 

  6. Tweet MS, Miller VM, Hayes SN. The evidence on estrogen, progesterone, and spontaneous coronary artery dissection. JAMA Cardiol. 2019;4:403–4. https://doi.org/10.1001/jamacardio.2019.0774.

    Article  PubMed  Google Scholar 

  7. Sharma S, Kaadan MI, Duran JM, Ponzini F, Mishra S, Tsiaras SV, et al. Risk factors, imaging findings, and sex differences in spontaneous coronary artery dissection. Am J Cardiol. 2019;123(11):1783–7. https://doi.org/10.1016/j.amjcard.2019.02.040.

    Article  PubMed  Google Scholar 

  8. DeFilippis EM, Collins BL, Singh A, Biery DW, Fatima A, Qamar A, et al. Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry. Eur Heart J. 2020;41(42):4127–37. https://doi.org/10.1093/eurheartj/ehaa662.

    Article  PubMed  Google Scholar 

  9. Al-Hussaini A, Adlam D. Spontaneous coronary artery dissection. Heart. 2017;103(13):1043–51. https://doi.org/10.1136/heartjnl-2016-310,320.

    Article  PubMed  Google Scholar 

  10. Prati F, Regar E, Mintz GS, Arbustini E, Di Mario C, Jang IK, et al. Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J. 2010;31(4):401–15. https://doi.org/10.1093/eurheartj/ehp433.

    Article  PubMed  Google Scholar 

  11. Alfonso F, Paulo M, Gonzalo N, Dutary J, Jimenez-Quevedo P, Lennie V, et al. Diagnosis of spontaneous coronary artery dissection by optical coherence tomography. J Am Coll Cardiol. 2012;59(12):1073–9. https://doi.org/10.1016/j.jacc.2011.08.082.

    Article  PubMed  Google Scholar 

  12. • Tweet MS, Gulati R, Williamson EE, Vrtiska TJ, Hayes SN. Multimodality imaging for spontaneous coronary artery dissection in women. JACC Cardiovasc Imaging. 2016;9(4):436–50. https://doi.org/10.1016/j.jcmg.2016.01.009. A detailed review of optimal use of echo, CCTA, and MRI in SCAD.

  13. • Gupta S, Meyersohn N, Wood MJ, et al. Role of coronary CT angiography in spontaneous coronary artery dissection. Radiology: Cardiothoracic Imaging. 2020;2(6). https://doi.org/10.1148/ryct.2020200364. An excellent detailed manuscript summarizing CCTA findings in SCAD.

  14. Pozo-Osinalde E, García-Guimaraes M, Bastante T, Aguilera MC, Rodríguez-Alcudia D, Rivero F, et al. Characteristic findings of acute spontaneous coronary artery dissection by cardiac computed tomography. Coron Artery Dis. 2020;31(3):293–9. https://doi.org/10.1097/MCA.0000000000000819.

    Article  PubMed  Google Scholar 

  15. • Tan NY, Hayes SN, Young PM, Gulati R, Tweet MS. Usefulness of cardiac magnetic resonance imaging in patients with acute spontaneous coronary artery dissection. Am J Cardiol. 2018;122(10):1624–9. https://doi.org/10.1016/j.amjcard.2018.07.043. Detailed information on use of cardiac MRI and nuances in patients with SCAD vs. Takotsubo cardiomyopathy.

  16. Chou AY, Sedlak T, Aymong E, Sheth T, Starovoytov A, Humphries KH, et al. Spontaneous coronary artery dissection misdiagnosed as Takotsubo cardiomyopathy: a case series. Can J Cardiol. 2015;31(8):1073.e5–8. https://doi.org/10.1016/j.cjca.2015.03.018.

    Article  Google Scholar 

  17. Duran JM, Naderi S, Vidula M, Michalak N, Chi G, Lindsay M, et al. Spontaneous coronary artery dissection and its association with Takotsubo syndrome: novel insights from a tertiary center registry. Catheter Cardiovasc Interv. 2020;95(3):485–91. https://doi.org/10.1002/ccd.28314.

    Article  PubMed  Google Scholar 

  18. Y-Hassan S. Spontaneous coronary artery dissection and Takotsubo syndrome: an often overlooked association; review. Cardiovasc Revasc Med. 2018;19(6):717–23. https://doi.org/10.1016/j.carrev.2018.02.002.

    Article  PubMed  Google Scholar 

  19. Bolen MA, Brinza E, Renapurkar RD, Kim ESH, Gornik HL. Screening CT angiography of the aorta, visceral branch vessels, and pelvic arteries in fibromuscular dysplasia. JACC Cardiovasc Imaging. 2017;10(5):554–61. https://doi.org/10.1016/j.jcmg.2016.04.010.

    Article  PubMed  Google Scholar 

  20. Gornik HL, Persu A, Adlam D, Aparicio LS, Azizi M, et al. First international consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med. 2019;24(2):164–89. https://doi.org/10.1177/1358863X18821816.

    Article  PubMed  Google Scholar 

  21. Verstraeten A, et al. Collaborators of the European/International Fibromuscular Dysplasia Registry and Initiative (FEIRI). Enrichment of rare variants in Loeys-Dietz syndrome genes in spontaneous coronary artery dissection but not in severe fibromuscular dysplasia. Circulation. 2020;142(10):1021–4. https://doi.org/10.1161/CIRCULATIONAHA.120.045946.

    Article  CAS  PubMed  Google Scholar 

  22. Michelis JC, Olin JW, Kadian-Dodov D, d’Escamard V, Kovacic JC. Coronary artery manifestations of FMD. J Am Coll Cardiol. 2014;64(10):1033–46. https://doi.org/10.1016/j.jacc.2014.07.014.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Vijayaraghavan R, Verma S, Gupta N, Saw J. Pregnancy-related spontaneous coronary artery dissection. Circulation. 2014;130(21):1915–20. https://doi.org/10.1161/CIRCULATIONAHA.114.011422.

    Article  PubMed  Google Scholar 

  24. Tweet MS, Hayes SN, Codsi E, Gulati R, Rose CH, Best PJM. Spontaneous coronary artery dissection associated with pregnancy. J Am Coll Cardiol. 2017;70(4):426–35. https://doi.org/10.1016/j.jacc.2017.05.055.

    Article  PubMed  Google Scholar 

  25. Adlam et al. for the SCAD Collaborative Group. Abstract 10,590: long-term outcomes in pregnancy related vs. non-pregnancy related spontaneous coronary artery dissection: an international multi-center collaborative study. Circulation. 2019;140:10590.

  26. Codsi E, Tweet MS, Rose CH, Arendt KW, Best PJM, Hayes SN. Spontaneous coronary artery dissection in pregnancy: what every obstetrician should know. Obstet Gynecol. 2016;128(4):731–8. https://doi.org/10.1097/AOG.0000000000001630.

    Article  PubMed  Google Scholar 

  27. •• Kok SN, Tweet MS. Recurrent spontaneous coronary artery dissection. Expert review of cardiovascular therapy. https://doi.org/10.1080/14779072.2021.1877538. Reviews what we currently understand about recurrence of SCAD.

  28. Kronzer VL, Tarabochia AD, Lobo Romero AS, Tan NY, O’Byrne TJ, Crowson CS, et al. Lack of association of spontaneous coronary artery dissection with autoimmune disease. J Am Coll Cardiol. 2020;76(19):2226–34. https://doi.org/10.1016/j.jacc.2020.09.533.

    Article  PubMed  Google Scholar 

  29. Franke KB, Nerlekar N, Marshall H, Psaltis PJ. Systematic review and meta-analysis of the clinical characteristics and outcomes of spontaneous coronary artery dissection. Int J Cardiol. 2021;322:34–9. https://doi.org/10.1016/j.ijcard.2020.08.076.

    Article  PubMed  Google Scholar 

  30. Saw J, Humphries K, Aymong E, Sedlak T, Prakash R, Starovoytov A, et al. Spontaneous coronary artery dissection: clinical outcomes and risk of recurrence. J Am Coll Cardiol. 2017;70(9):1148–58. https://doi.org/10.1016/j.jacc.2017.06.053.

    Article  PubMed  Google Scholar 

  31. Rigatelli G, Dell’Avvocata F, Picariello C, Zuin M, Giordan M, Roncon L. Characterization of single vs. recurrent spontaneous coronary artery dissection. Asian Cardiovasc Thorac Ann. 2018;26(2):89–93. https://doi.org/10.1177/0218492318757041.

    Article  PubMed  Google Scholar 

  32. Tweet MS, Codsi E, Best PJM, Gulati R, Rose CH, Hayes SN. Menstrual chest pain in women with history of spontaneous coronary artery dissection. J Am Coll Cardiol. 2017;70(18):2308–9. https://doi.org/10.1016/j.jacc.2017.08.071.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tweet MS, Young KA, Rose CH, Best PJ, Gulati R, Hayes SN. Abstract 13,043: pregnancy after spontaneous coronary artery dissection: a case series of 22 women and 31 pregnancies. Circulation. 2019;140:A13043.

    Google Scholar 

  34. •• Tweet MS, Young KA, Best PJM, Hyun M, Gulati R, Rose CH, et al. Association of pregnancy with recurrence of spontaneous coronary artery dissection among women with prior coronary artery dissection. JAMA Netw Open. 2020;3(9):e2018170. https://doi.org/10.1001/jamanetworkopen.2020.18170. Provides insight into a common and challenging clinical scenario, i.e., how to counsel women who desire pregnancy after SCAD.

  35. Henkin S, Negrotto SM, Tweet MS, Kirmani S, Deyle DR, Gulati R, et al. Spontaneous coronary artery dissection and its association with heritable connective tissue disorders. Heart. 2016;102(11):876–81. https://doi.org/10.1136/heartjnl-2015-308,645.

    Article  PubMed  Google Scholar 

  36. Nakamura M, Yajima J, Oikawa Y, Ogasawara K, Uejima T, Abe K, et al. Vascular Ehlers-Danlos syndrome--all three coronary artery spontaneous dissections. J Cardiol. 2009;53(3):458–62. https://doi.org/10.1016/j.jjcc.2008.09.007.

    Article  PubMed  Google Scholar 

  37. • Kaadan MI, MacDonald C, Ponzini F, Duran J, Newell K, Pitler L, et al. Prospective cardiovascular genetics evaluation in spontaneous coronary artery dissection. Circ Genom Precis Med. 2018;11(4):e001933. https://doi.org/10.1161/CIRCGENETICS.117.001933. Valuable and clinically helpful information on their own findings as well as summary of current understanding of genetics and SCAD.

  38. Kiando SR, Tucker NR, Castro-Vega LJ, Katz A, D’Escamard V, Tréard C, et al. PHACTR1 is a genetic susceptibility locus for fibromuscular dysplasia supporting its complex genetic pattern of inheritance. PLoS Genetics. 2016;12(10):e1006367. https://doi.org/10.1371/journal.pgen.1006367.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. •• Adlam D, et al. Association of the PHACTR1/EDN1 genetic locus with spontaneous coronary artery dissection. J Am Coll Cardiol. 2019;73(1):58–66. https://doi.org/10.1016/j.jacc.2018.09.085. Novel paper that helps us better understand the association of FMD, migraines, cervicocerebral dissection and SCAD.

  40. • Turley TN, O’Byrne MM, Kosel ML, de Andrade M, Gulati R, Hayes SN, et al. Identification of susceptibility loci for spontaneous coronary artery dissection. JAMA Cardiol. 2020;5(8):1–10. https://doi.org/10.1001/jamacardio.2020.0872. Cutting edge GWAS in SCAD that opens up doors for future research inquiry.

    Article  PubMed Central  Google Scholar 

  41. • Saw J, Yang ML, Trinder M, Tcheandjieu C, Xu C, Starovoytov A, et al. Chromosome 1q21.2 and additional loci influence risk of spontaneous coronary artery dissection and myocardial infarction. Nat Commun. 2020;11(1):4432. https://doi.org/10.1038/s41467-020-17,558-x. Cutting edge GWAS in SCAD that opens up doors for future research inquiry.

  42. Kok SN, Hayes SN, Cutrer FM, Raphael CE, Gulati R, Best PJM, et al. Prevalence and clinical factors of migraine in patients with spontaneous coronary artery dissection. J Am Heart Assoc. 2018;7(24):e010140. https://doi.org/10.1161/JAHA.118.010140.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kaumann AJ, Frenken M, Posival H, Brown AM. Variable participation of 5-HT1-like receptors and 5-HT2 receptors in serotonin-induced contraction of human isolated coronary arteries. 5-HT1-like receptors resemble cloned 5-HT1D beta receptors. Circulation. 1994;90(3):1141–53. https://doi.org/10.1161/01.cir.90.3.1141.

    Article  CAS  PubMed  Google Scholar 

  44. Alzubi J, Jabri A, Hedrick D. Abstract 15,755: spontaneous coronary artery dissection following exposure to triptan. Circulation. 2019;140:A15755.

    Google Scholar 

  45. Abu-Haniyeh A, Goyal A, Faulx M. Abstract 12,091: -vessel spontaneous coronary artery dissection after triptan exposure. Circulation. 2018;138:A12091.

    Google Scholar 

  46. • Oakes TM, Kovacs R, Rosen N, Doty E, Kemmer P, Aurora SK, et al. Evaluation of cardiovascular outcomes in adult patients with episodic or chronic migraine treated with galcanezumab: data from three phase 3, randomized, double-blind, placebo-controlled EVOLVE-1, EVOLVE-2, and REGAIN studies. Headache. 2020;60(1):110–23. https://doi.org/10.1111/head.13684. Clinically helpful in counseling patients with migraine and SCAD.

  47. Krittanawong C, Tweet MS, Hayes SE, Bowman MJ, Gulati R, Squires RW, et al. Usefulness of cardiac rehabilitation after spontaneous coronary artery dissection. Am J Cardiol. 2016;117(10):1604–9. https://doi.org/10.1016/j.amjcard.2016.02.034.

    Article  PubMed  Google Scholar 

  48. Chou AY, Prakash R, Rajala J, Birnie T, Isserow S, Taylor CM, et al. The first dedicated cardiac rehabilitation program for patients with spontaneous coronary artery dissection: description and initial results. Can J Cardiol. 2016;32(4):554–60. https://doi.org/10.1016/j.cjca.2016.01.009.

    Article  PubMed  Google Scholar 

  49. •• Johnson AK, Hayes SN, Sawchuk C, Johnson MP, Best PJ, Gulati R, et al. Analysis of posttraumatic stress disorder, depression, anxiety, and resiliency within the unique population of spontaneous coronary artery dissection survivors. J Am Heart Assoc. 2020;9(9):e014372. https://doi.org/10.1161/JAHA.119.014372. Highlights important mental health considerations in the care of SCAD patients.

  50. Edwards KS, Vaca KC, Naderi S, Tremmel JA. Patient-reported psychological distress after spontaneous coronary artery dissection: evidence for post-traumatic stress. J Cardiopulm Rehabil Prev. 2019;39(5):E20–3. https://doi.org/10.1097/HCR.0000000000000460.

    Article  PubMed  Google Scholar 

  51. Wagers TP, Stevens CJ, Ross KV, Leon KK, Masters KS. Spontaneous coronary artery dissection (SCAD): female survivors’ experiences of stress and support. J Cardiopulm Rehabil Prev. 2018;38(6):374–9. https://doi.org/10.1097/HCR.0000000000000330.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82. https://doi.org/10.1002/da.10113.

    Article  PubMed  Google Scholar 

  53. Loprinzi CE, Prasad K, Schroeder DR, Sood A. Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: a pilot randomized clinical trial. Clin Breast Cancer. 2011;11(6):364–8. https://doi.org/10.1016/j.clbc.2011.06.008.

    Article  PubMed  Google Scholar 

  54. Bhagra A, Medina-Inojosa JR, Vinnakota S, Arciniegas MC, Garcia M, Sood A, et al. Stress management and resilience intervention in a women’s heart clinic: a pilot study. J Womens Health (Larchmt). 2019;28:1705–10. https://doi.org/10.1089/jwh.2018.7216.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA

    Shimoli Shah MD

  2. Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN, 55905, USA

    Marysia Tweet MD

Authors
  1. Shimoli Shah MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marysia Tweet MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shimoli Shah MD.

Ethics declarations

Conflict of Interest

Shimoli Shah declares that she has no conflict of interest. Marysia Tweet declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Reproductive Health and Cardiovascular Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shah, S., Tweet, M. Imaging of Spontaneous Coronary Artery Dissection and Counseling Patients of Reproductive Age. Curr Treat Options Cardio Med 23, 52 (2021). https://doi.org/10.1007/s11936-021-00927-0

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11936-021-00927-0

Keywords

Search

Navigation