SCAD SCARE

Dr. Kholghi presented a classic case of spontaneous coronary artery dissection (SCAD) in a young woman with prior IVF pregnancies who was admitted with chest pain and this EKG:

Yikes! Residents quickly identified the ST elevations in the inferior & lateral leads with reciprocal ST depressions.  How is this different than the EKG changes seen in acute pericarditis? In pericarditis, the ST elevations are typically diffuse and concave with associated PR-segment depressions. Reciprocal ST depressions (as seen in this EKG), are not expected in pericarditis.

Yikes! Residents quickly identified the ST elevations in the inferior & lateral leads with reciprocal ST depressions.

How is this different than the EKG changes seen in acute pericarditis? In pericarditis, the ST elevations are typically diffuse and concave with associated PR-segment depressions. Reciprocal ST depressions (as seen in this EKG), are not expected in pericarditis.

Code STEMI was activated and the patient was taken for cath, which revealed a dissection of the OM1.

cath.JPG

Take Away Points

  • Consider a diagnosis of SCAD in a young women presenting with chest pain or ACS  

  • Risk factors include postpartum status, multiparity and exposure to hormonal therapy, so this is important historical information to gather

  • Conservative therapy (rather than revascularization), is the preferred treatment strategy

Below is a link for a related case from NEJM Case Records of the Massachusetts General Hospital (thanks for the recommendation, Dr. Burnett!)