Imaging of Spontaneous Coronary Artery Dissection and Counseling Patients of Reproductive Age

Purpose of review: This review highlights issues relevant to women of reproductive age with a history of spontaneous coronary artery dissection (SCAD). Recent findings: Current topics regarding the care of SCAD patients include multimodality imaging, pregnancy, lactation, SCAD recurrence, reproductive counseling, migraines, cardiac rehabilitation, and mental health. While no single disease-causing gene for SCAD has been discovered, recent genome-wide association studies show promise for future understanding of underlying mechanisms and risk for SCAD. Summary: Patients with history of SCAD require dedicated, multidisciplinary care, and women of reproductive age necessitate specific discussion regarding pregnancy, contraception, and menses. Imaging to detect fibromuscular dysplasia and other arteriopathies is recommended in all patients. Pregnancy after SCAD is discouraged, although counseling must be tailored. Systemic exogenous hormones have not been shown to definitively increase the risk of SCAD, but nonhormonal treatment approaches are preferred. Triptan therapy should be discouraged in SCAD patients with migraines, and more research is needed to understand the safety of newer agents. Cardiac rehabilitation after SCAD is safe and encouraged. All SCAD survivors should be screened for post-traumatic stress disorder, depression, and anxiety regardless of time from initial event.