Coda Change SCAD will also screw you up by David Carr
Jul 7, 2021
David Carr, a cardiology clinician and educator, dives into the riveting case of a 33-year-old postpartum woman with severe chest pain. He unpacks the complexities of spontaneous coronary artery dissection (SCAD), detailing its symptoms and prevalence, particularly in women under 50. Carr emphasizes the vital 'plus one' rule for recognizing SCAD in young, stressed women. He discusses the hormonal influences and the importance of conservative management in these cases, challenging common emergency protocols.
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Postpartum STEMI That Spooked The Clinician
- David Carr describes a 33-year-old woman 36 hours postpartum presenting with crushing chest pain and an anterior STEMI on ECG.
- He was spooked because the presentation looked like a classic MI despite her young postpartum profile.
SCAD Often Mimics Classic ACS
- SCAD can mimic classic ACS with identical history, ECG changes, and biomarkers, so phenotype (who it affects) matters diagnostically.
- David Carr emphasizes that SCAD looks like a duck but occurs in patients who don't fit typical MI profiles.
Demographics Skew Strongly Toward Young Women
- SCAD predominantly affects women at a younger age, with mean age around 43 and up to 91% under 25 in one statement of the transcript.
- It accounts for a large proportion of MIs in women under 50 (up to 43%), marking it as a disorder skewed by sex and age.