Spontaneous Coronary artery Dissection Dr Dave Adlam SCAD - - PowerPoint PPT Presentation

Spontaneous Coronary artery Dissection

Dr Dave Adlam SCAD conference 7th November 2015

Welcome to Leicester!

Thanks!

SCAD UK/EU

• 1. Research
• 2. Support
• 3. Education

What is SCAD?

Tear or spontaneous bruise?

How do doctors know what is SCAD?

It’s not always easy but it usually looks different…

The ECG

Other tests

• Cardiac ultrasound – ECHO
• Blood tests – Troponin
• Other tests – e.g. CT scan to exclude

pulmonary embolus

• Coronary angiography

SCAD may cause a heart attack

• When an affected artery becomes completely

blocked by the dissection

• When blood flow down the affected artery is

not enough to keep the heart muscle going

• When a branch vessel is compromised by the

dissection

Heart damage after SCAD heart attack

• Depends on the vessel affected and the

amount of heart muscle supplied

• Timing and nature of treatment
• This affects your treatment as some

treatments are more important in SCAD- survivors with more damaged hearts

Why me?

• Increased risk in females and post partum
• Genetics?
• Connective tissue disorder?
• Exercise?
• Stress?

What treatment did I have at the time and why?

• Medicines only – ‘conservative’

• Stents

• Challenges with stents

A B C

• Bypass surgery

Treatment after SCAD. What now?

Which medication?

• Which medication?
• Antiplatelet treatments (Aspirin, Clopidogrel, Ticagrelor,

Prasugrel)

• Beta blockers (end on ‘lol e.g. bisoprolol, atenolol)
• ACE inhibitors (end in ‘pril e.g. ramipril, lisinopril),

angiotensin receptor antagonists (end in ‘sartan e.g. lostartan, candesartan)

• Statins and other cholesterol treatments
• Mineralocorticoid receptor antagonists (end in ‘one e.g.

spironolactone, eplerinone)

• Vasodilators (e.g. nitrates, calcium channel blockers)

Particular medical issues in SCAD-survivors

• Menorrhagia (increased menstrual bleeding)

related to antiplatelet therapies

• Contraception
• Recurrent chest pains (? Coronary spasm)
• Post traumatic stress disorder (PTSD), anxiety

and depression

• Do I need a defibrillator?
• Exercise?

What further tests do I need?

• Clinical versus research?
• Assessment of coronary artery healing
• Assessment of heart function
• Assessment of arteries elsewhere in the body

Should my family be tested?

• Genetic association?

What is the risk of pregnancy?

What is the risk of recurrence?

CIRCINTERVENTIONS.114.001659

SCAD research

• SCAD UK/EU
• Mayo Clinic USA
• British Columbia Canada
• SCAD Alliance

Aims of SCAD UK/EU

• To conduct research to better understand the

causes of SCAD with the aim of improving the prevention of SCAD and the treatment of SCAD-survivors

• To support and advise SCAD-survivors
• To educate medical, nursing and paramedical

professionals to enhance the early accurate diagnosis of SCAD

SCAD Research

SCAD Research


Current aims of SCAD research

• To study and understand the patient experience of SCAD
• To collect data on how patients with SCAD are currently managed in

the UK and EU

• To better understand the spectrum of the acute presentation of

SCAD

• To investigate how the heart responds to /recovers after SCAD
• To understand the frequency, nature and extent of non-cardiac

vascular abnormalities in SCAD-survivors

• To look for biomarkers of SCAD
• To investigate genetic causes / risk markers for SCAD
• To investigate if abnormalities of connective tissue lead to SCAD

Main research tools

• The medical and imaging records of SCAD

survivors

• The online questionnaire
• Blood/DNA tests
• The research day

The research day…

Research findings

Image 15-10099 SCAD010/SV Method 1 Image 15-10107 SCAD010/SV Method 1 Image 15-10103 SCAD010/SV Method 1 Image 15-10093 SCAD010/SV Method 1 Image 15-10094 SCAD010/SV Method 1 Image 15-10110 SCAD010/SV Method 1

Method 1 (No UA+ Ethanol ) Single Staining (SCAD 010/SV)

Image 15-10078 SCAD010/SV Method 4 Image 15-10080 SCAD010/SV Method 4

Method 4 (UA+ Propylene) Double Staining (SCAD010/SV)

Image 15-10071 SCAD010/SV Method 4 Image 15-10073 SCAD010/ SV Method 4 Image 15-10064 SCAD010/SV Method 4

Image 15-10113 SCAD014/LB Method 3 Image 15-10114 SCAD014/LB Method 3

Method 3 (UA+ Ethanol) Single Staining (SCAD014/LB)

Image 15-10113 SCAD022/LB Method 3 Image 15-10120 SCAD014/LB Method 3

Method 1 (No UA+ Ethanol) Single Staining (SCAD014/LB)

Image 15-10146 SCAD014/LB Method 3 Image 15-10151 SCAD014/LB Method 3 Image 15-10157 SCAD014/LB Method 3 Image 15-10136 SCAD014/LB Method 3

Method 5 (NO Ua+ Propylene+ Epoxy) Single Staining (SCAD021/KA)

Image 15-10170 SCAD021/KA Method 5 coffin mould Image 15-10171 SCAD021/KA Method 5 coffin mould Image 15-10178 SCAD021/KA Method 5 coffin mould Image 15-10182 SCAD021/KA Method 5 coffin mould Image 15-10183SCAD021/KA Method 5 coffin mould

Method 5 (NO Ua+ Propylene+ Epoxy) Single Staining (SCAD027/NA)

Image 15-10199 SCAD027/NA Method 5 coffin mould Image 15-10205 SCAD027/NA Method 5 coffin mould Image 15-10208 SCAD027/NA Method 5 coffin mould

Future directions

• Collaboration, collaboration, collaboration
• Extension of BHF funding (application early

2016)

• ESC?

Thanks to

• The SCAD-survivors
• Abi
• Our funders (BHF and NIHR)
• Everyone at the Leicester NIHR Cardiovascular

Biomedical Research Unit