Miscellaneous - Women, Elderly and CVD Flashcards
SCAD: is it common in postpartum period?
about 18% occurred during postpartum
SCAD: most common presentation (ACS)
STEMI
SCAD: Precipitating factor - most
high emotional stress
appearance of SCAD
either intramural hematoma OR intimal tear
Types of SCAD in coronary angiogram
Question?
C- 50%
***10 year recurrence rate: 20% either treated with revasc or conservatively
Indication for PCI in SCAD
SCAD pt with on going ischemia or unstable hemodynamics
other vascular abnormality associated with SCAD
FMD - most commonly affected organ-> renal
*** post SCAD recommendation: CTA brain to pelvis
Extra-coronary vascular involvement in SCAD
Is statin indicated for patient with SCAD
- only if there is other indication.
Mechanism of anginal in SCAD
- vasospasm could be present
FMD - most common affected site
carotid and renal arteries
How common is STEMI with normal coronaries?
about 5%
- of which, Myocarditis and Stress Cardiomyopathy is most common cause
***other causes
- EMbolic
- PE
- Coronary artery spasm
- ascending aortic dissection involving a coronary artery
Pathophysiology of coronary artery spasm
- Tobacco use
- Ephedrine used
- Cocaine, amphetamines
- changes in autonomic function
Diagnostic criteria for Coronary Artery Vasospasm
***Ach normally cause vasodilation
study that showed 25% with ACS have no obstructive CAD and 50% of which has coronary vasospasm by Ach provocative testing
CASPAR study
drug that relieve anginal in Coronary artery vasospasm
- diltiazem
how common is apical ballooning in stress cardiomyopathy?
82%
most common trigger of stress cardiomyopathy
Physical is more common than emotional
Possible etiologies for MI with Non-Obstructive Coronary Arteries (MINOCA)
- LAD branch vessel occlusion
- Microvascular atherosclerosis
- Embolic phenomenon
- Vasospasm
- SCAD
- Myocarditis
Prevalence of MINOCA
6% of ACS
Question
–> Cardiac MRI
r/out Myocarditis
