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Idiopathic spontaneous coronary artery dissection — Clinical Guidelines

Overview

Spontaneous coronary artery dissection (SCAD) is a cause of myocardial infarction, predominantly affecting young, otherwise healthy individuals, with a notable female predominance 1 3.

Diagnosis

Consider SCAD in young, healthy patients presenting with cardiac ischemia symptoms 3.

Cardiac biomarker testing is essential for initial evaluation 3.

Cardiac catheterization may be necessary for diagnosis and treatment if unstable symptoms or ongoing ischemia persist 3.

Management

Cardiac rehabilitation (CR) is recommended to promote physical and mental recovery 1 4.

Approximately 76% of patients with SCAD participate in CR, reporting physical and emotional benefits 4.

Common barriers to CR participation include lack of recommendation by healthcare providers, transportation issues, and financial constraints 4.

Special Populations

No specific data provided for pregnancy, pediatrics, elderly, or comorbidities in the given abstracts.

Key Recommendations

Include cardiac biomarker testing in the initial evaluation of young patients with possible cardiac symptoms to rule out SCAD (Evidence: Moderate 3).

Recommend cardiac rehabilitation for patients post-SCAD to enhance recovery, addressing identified barriers such as provider recommendation and accessibility (Evidence: Moderate 1 4).

Consider cardiac catheterization for diagnosis and potential treatment in cases of unstable symptoms or ongoing ischemia (Evidence: Moderate 3).

References

1 Stragapede E, Bouchard K, Coutinho T, Mulvagh S, Pacheco C, Liu S et al.. Sex differences in secondary prevention needs and recommendations among patients with spontaneous coronary artery dissection. European journal of cardiovascular nursing 2025. link 2 Murphy BM, Rogerson MC, Iismaa SE, Hesselson S, Le Grande MR, Graham RM et al.. Attitudes to and Attendance at Cardiac Rehabilitation After Spontaneous Coronary Artery Dissection. Journal of cardiopulmonary rehabilitation and prevention 2025. link 3 Wood MJ, Drachman DE. "Typical symptoms in the atypical patient? Consider SCAD!". Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2017. link 4 Krittanawong C, Tweet MS, Hayes SE, Bowman MJ, Gulati R, Squires RW et al.. Usefulness of Cardiac Rehabilitation After Spontaneous Coronary Artery Dissection. The American journal of cardiology 2016. link

Idiopathic spontaneous coronary artery dissection