Treatment

The goal of treatment for spontaneous coronary artery dissection (SCAD) is to restore blood flow to your heart. In some cases this healing will occur naturally. In others, doctors may have to restore blood flow by opening the artery with a balloon or stent, or surgically bypassing the artery.

The treatments most appropriate for you will depend on your condition, including the size and location of the tear in your artery, as well as any signs or symptoms you're experiencing. Whenever possible, doctors allow the damaged artery to heal on its own, rather than repairing it through invasive procedures.

For some people, medications may relieve symptoms of spontaneous coronary artery dissection (SCAD). In these situations, it may be possible to be treated by medications alone. If chest pain or other symptoms persist, other treatments may be needed.

Placing a stent to hold the artery open

If your spontaneous coronary artery dissection (SCAD) has blocked blood flow to your heart or if medications don't control your chest pain, your doctor may recommend placing a tiny mesh tube (stent) inside your artery to hold it open. A stent can help restore blood flow to your heart.

To position the stent, doctors insert a long, thin tube (catheter) into an artery — usually in your leg or arm — and thread the tube to the arteries in your heart. The catheter is guided to your damaged artery using X-rays.

A wire with a deflated balloon is passed through the catheter to the tear in the artery. The balloon is then inflated, expanding the stent against your artery walls. The stent is left in place to hold the artery open.

Surgery to bypass the damaged artery

If other treatments haven't worked or if you have more than one tear in an artery, your doctor may recommend surgery to create a new way for blood to reach your heart.

Coronary bypass surgery involves removing a blood vessel from another part of your body, such as your leg. That blood vessel is stitched into place so that it diverts blood flow around your damaged artery.

Medications

After spontaneous coronary artery dissection (SCAD), your doctor may recommend medications, including:

  • Aspirin. Aspirin may help prevent cardiovascular disease problems after spontaneous coronary artery dissection (SCAD).
  • Blood-thinning drugs. Drugs that reduce the number of blood-clotting platelets in your blood (anticoagulants) can reduce the risk of a clot forming in your torn artery.
  • Blood pressure drugs. Drugs used to treat high blood pressure can lower your heart's demand for blood, reducing the pressure in your damaged artery. You may continue to take blood pressure drugs indefinitely to reduce the risk of another spontaneous coronary artery dissection (SCAD).
  • Medications to control chest pain. These medications (nitrates and calcium channel blockers) can help treat chest pain you may experience after spontaneous coronary artery dissection (SCAD).
  • Cholesterol drugs. People who have abnormal cholesterol levels and other risk factors may need to take medications to control their cholesterol levels.

Continuing care

After your treatment for spontaneous coronary artery dissection (SCAD), you'll need regular follow-up appointments with your doctor to monitor for any changes in your condition. Your doctor may also recommend other types of care to help you recover and to prevent other health problems. These may include:

  • Undergoing cardiac rehabilitation. Cardiac rehabilitation is a customized program of exercise and education designed to help you recover from a serious heart condition, such as a heart attack caused by spontaneous coronary artery dissection (SCAD). Cardiac rehabilitation often includes monitored exercise, nutritional counseling, emotional support and education.
  • Reviewing your family medical history. Some inherited conditions, such as the connective tissue disease Marfan syndrome, have been found to occur in people who experience spontaneous coronary artery dissection (SCAD). Your doctor may refer you to a genetic counselor to review your family medical history and determine whether genetic testing may be appropriate for you.
  • Looking for weaknesses in other blood vessels. Your doctor may recommend using CT angiography to look for weaknesses and abnormalities in other blood vessels, such as fibromuscular dysplasia (FMD).
Sept. 14, 2016
References
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