SCAD will also screw you up by David Carr

Carr's Clinic is back but this time - with the man himself. David Carr walks us through a case which had him spooked (and for good reason).

A 33 year old female comes into the Emergency Room with crushing chest pain.

She has terrible pain radiating down her arm and it has only been 36 hours since she gave birth to her fifth kid.

Her ECG showed a STEMI. But, 33 year old women who just gave birth don't have MI's. Do they?

Turns out, she has SCAD - Spontaneous coronary artery dissection.

SCAD represents 1 to 4% of all ACS angiograms.

30% of the time it presents as a STEMI and 70% of the time as a non-STEMI.

The kicker? SCAD looks like STEMI. It has the same story, the same ECG, the same biomarker that is positive... it just depends on who is getting it.

91% of people with SCAD are less than the age of 25 and 85-94% are women.

It also represents 43% of MIs in women under the age of 50.

So how do we catch it? Think about the plus ones.

ACS plus young woman with no risk factors.

ACS plus pregnant or postpartum.

ACS plus some significant stressor.

SCAD is something we need to remember and we need to consider.

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