Citations

Purpose. Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome predominantly affecting women. Although the knowledge of SCAD has expanded over the past 2 decades, limited evidence exists to guide post-event management and prevention of future adverse events. This review aims to synthesize the current understanding of SCAD and outline considerations for exercise prescription and cardiac rehabilitation (CR) in this unique population. Review Methods. A comprehensive literature review was conducted, incorporating original research articles, systematic reviews, meta-analyses, and current clinical guidelines related to SCAD and CR. Summary. Current literature demonstrates that CR is safe in this population and is associated with improvement in measures of physical and mental health. Expert consensus supports reintroduction of exercise and an individualized multidisciplinary CR framework.This review highlights current evidence and expert recommendations for the multidisciplinary outpatient management of patients with SCAD.

Background: Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome in women. Although the role of sex-hormones in the pathogenesis of SCAD is unclear, menopausal hormone therapy (HT) after SCAD is generally dissuaded. This limits management options for women with menopausal symptoms, the burden of which among SCAD patients is unknown. Aims: To quantify the burden of menopausal symptoms among women with a history of SCAD. Methods: We surveyed 1617 participants in the Mayo Clinic SCAD "Virtual" Multi-Center Registry on the topic of menopausal symptoms. Among women who had completed key portions of the survey (N = 846), 666 were identified as being either peri or post-menopausal based on patient report. Results: Menopausal symptom prevalence was high in women with SCAD (Figure). Many women (45%) experienced weight changes in the prior 6 months, and most (75%) never used HT for their menopausal symptoms. Forty-five (6%) women experienced menopause at age 45 or younger, and five (1%) experienced menopause at 40 or younger. At the time of the survey, intravaginal estrogen (11.4%) was the most common HT used, while all other individual HT therapies were used by fewer than 5%. Conclusions: Peri- and postmenopausal women with SCAD experience a high burden of menopausal symptoms, and very few use HT outside of intravaginal estrogen. These findings highlight the need for further exploration of treatment strategies for women with menopausal symptoms following SCAD including assessment of benefits versus harms in the subset of women with premature menopause.

Ischemic monomelic neuropathy (IMN) is a rare peripheral neuropathy caused by limb ischemia and subsequent nerve degeneration, typically manifesting with unilateral pain, paresthesia, and numbness without overt signs of limb ischemia. This case report describes a 59-year-old female with extensive peripheral artery disease who developed IMN in her right lower extremity following an acute, intraoperative in-sheath thrombosis during a right femoral endarterectomy and external iliac artery stent placement, a rare etiology distinct from the more commonly reported associations with bypass surgery or hemodialysis access. Despite successful intraoperative revascularization, the patient developed diminished motor and sensory function with unremitting pain, and subsequent electromyography confirmed a length-dependent neuropathy with features of denervation, consistent with IMN. This case underscores the critical need for clinicians to consider IMN in the differential diagnosis of post-procedural neuropathic pain, even in the absence of classic ischemic signs and following seemingly successful vascular interventions, as acute thrombotic events during vascular procedures can precipitate this debilitating condition.