Spontaneous Coronary artery Dissection Dr Dave Adlam SCAD conference 7 th 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
Method 1 (No UA+ Ethanol ) Single Staining (SCAD 010/SV) Image 15-10094 SCAD010/SV Image 15-10093 SCAD010/SV Image 15-10099 SCAD010/SV Method 1 Method 1 Method 1 Image 15-10110 SCAD010/SV Image 15-10107 SCAD010/SV Image 15-10103 SCAD010/SV Method 1 Method 1 Method 1
Method 4 (UA+ Propylene) Double Staining (SCAD010/SV) Image 15-10073 SCAD010/ Image 15-10071 SCAD010/SV Image 15-10064 SCAD010/SV SV Method 4 Method 4 Method 4 Image 15-10078 SCAD010/SV Image 15-10080 SCAD010/SV Method 4 Method 4
Method 3 (UA+ Ethanol) Single Staining (SCAD014/LB) Image 15-10113 SCAD014/LB Image 15-10114 SCAD014/LB Method 3 Method 3 Image 15-10113 SCAD022/LB Image 15-10120 SCAD014/LB Method 3 Method 3
Method 1 (No UA+ Ethanol) Single Staining (SCAD014/LB) Image 15-10146 SCAD014/LB Image 15-10151 SCAD014/LB Method 3 Method 3 Image 15-10136 SCAD014/LB Image 15-10157 SCAD014/LB Method 3 Method 3
Method 5 (NO Ua+ Propylene+ Epoxy) Single Staining (SCAD021/KA) Image 15-10178 SCAD021/KA Image 15-10183SCAD021/KA Image 15-10170 SCAD021/KA Method 5 coffin mould Method 5 coffin mould Method 5 coffin mould Image 15-10171 SCAD021/KA Image 15-10182 SCAD021/KA Method 5 coffin mould Method 5 coffin mould
Method 5 (NO Ua+ Propylene+ Epoxy) Single Staining (SCAD027/NA) Image 15-10199 SCAD027/NA Image 15-10205 SCAD027/NA Method 5 coffin mould 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
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