# Current Knowledge and Challenges in the Clinical Management of Spontaneous Coronary Artery Dissection (SCAD): A Case Series

## TL;DR

This paper presents five cases of spontaneous coronary artery dissection to highlight its varied presentations and management challenges in clinical practice.

## Contribution

The study contributes a case series emphasizing the atypical presentation and management of SCAD in diverse patient populations.

## Key findings

- SCAD can present atypically and occurs in a wide age range, including young women.
- Conservative management was used in 60% of cases, while others required PCI.
- Complications such as heart failure and iatrogenic issues were observed in some patients.

## Abstract

Spontaneous coronary artery dissection (SCAD) is a rare condition in which there is coronary dissection that is not due to atherosclerosis or iatrogenic causes. It is more common in young women and is associated with risk factors such as the peripartum period and connective tissue disorders.

We present five unique cases of SCAD to illustrate the variety of presentations and clinical management. The youngest and oldest patients in our series were 34 and 63 years old, respectively. The majority of our patients (60%) were of African American ethnicity. Two of the patients in the case series developed a new-onset congestive heart failure, and one patient had an iatrogenic complication after intervention. The majority of the patients were treated with conservative medical management (60%), while the others were treated with primary percutaneous coronary intervention (PCI).

SCAD is a rare but life-threatening disease that may have varying presentations and precipitating risk factors. As demonstrated in our case series, SCAD may present atypically, and clinicians should maintain a high degree of suspicion in a relevant presentation. Treatment of SCAD may involve conservative management, primary PCI, or coronary artery bypass grafting (CABG) depending on the case. Clinicians may also have to address complications from SCAD, such as cardiomyopathy, that may arise.