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Spontaneous Coronary Artery Dissection: New Insights & Questions - Mayo Clinic CV Grand Rounds

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In this Mayo Clinic Grand Rounds video originally presented on November 30, 2012, cardiologists Rajiv Gulati, MD, PhD, and Sharonne Hayes, MD, discuss ...

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Mayo Clinic Healthcare Health care cardiology women's heart angiogram stent PCI fibrinolytics fibromuscular dysplasia acute coronary syndromes patient-initiated research SCAD pregnancy hormonal collagen defect recurrent SCAD extracoronary vascular imaging tortuosity aneurysms chest pain coronary spasm peripartum dissection cardiac rehabilitation Dr. Hayes Dr. Gulati offhand simple casual ad-lib down free natural planned intended according to pleasure ad libitum as one thinks best as one wishes at will extemporaneous extempore extemporize extemporized impromptu improvise improvised made-up off-the-cuff spontaneous unprepared unrehearsed without restraint autogenetic habitual impulsive instinctive instinctual intuitive involuntary knee-jerk mechanical perfunctory reflex routine unconscious unforced unintentional unmeditated unthinking unwilled accidental adventitious by chance contingent erratic fluky fortuitous incidental infrequent irregular occasional odd serendipitous uncertain unexpected unforeseen unplanned unpremeditated colloquial communicative conversational familiar friendly gabby garrulous gossipy informal intimate loose-lipped loquacious multieloquent talky artless childish credulous guileless immature ingenuous trustful trusting unaffected unfeigned at ease calm carefree comfortable comfy commodious composed content contented cozy cursive cushy easeful effortless flowing fluent forthright gentle in clover languid light mild moderate peaceful pleasant prosperous quiet running satisfied secure serene slow smooth snug soft substantial successful temperate thriving tranquil undemanding undisturbed unexacting unhurried untroubled unworried well-to-do automatic chatty childlike easy Spontaneous cardiac arrest angina pectoris chest pains tachycardia cardiovascular disease congestive heart failure coronary coronary infarction coronary thrombosis myocardial infarction heart attack duct tube sewer avenue route road canal track course way line alley artery clearing corridor egress gangway hallway ingress lane opening passage path walk drag highway thoroughfare approach aqueduct arroyo canyon carrier chamber chase conduit dig ditch fluting furrow gouge groove gully gutter main means medium pass pipe raceway runway slit sound strait tideway trough tunnel vein watercourse beltway interstate parkway superhighway thruway boulevard four-lane freeway parking lot pike roadway skyway street super slab toll road turnpike back street byway drive expressway pathway throughway aisle channel Artery late modern unusual current strange unique recent latest modish novel now topical unknown unlike untried unused virgin dewy like usual future worn old normal common past fresh other more another else extra farther further added improved altered changed renewed revived newly anew affixed appended increased new on the side option over-and-above padding perk spare supplementary afresh another time come again de novo from scratch from the beginning in a different way in a new way lately once again once more one more time over over again recently a distinct a further a separate one more some other that beat experimental head hip innovative lead leading-edge liberal new wave pioneering progressive radical state-of-the-art vanguard dubious flaky mostly working pre-release suspect testing unready bare barren clean empty pale plain spotless uncompleted unfilled unmarked untouched vacant vacuous virginal void white additional avant-garde beta blank N.E.W. acumen wisdom vision drift click ignorance stupidity acuity acuteness astuteness awareness brains brilliance cleverness comprehension cunning discernment discrimination farsightedness good taste grasp guile ingenuity insight intellect intelligence intuition judgment keenness perception percipience perspicacity perspicuity refinement sagacity sensitivity sharpness shrewdness smartness smarts understanding wit ESP feeling foreknowledge omen penetration precognition premonition psyche sixth sense telepathy acknowledgment apprehension attention knowledge mind need note notice observance observation reasoning recognition regard affinity appreciation being on same wavelength being there for someone communion community of interests compassion concord cottoning to good vibrations hitting it off picking up on pity rapport responsiveness soul sympathy warmth bodhi broad-mindedness civilization cultivation culture edification education information instruction learning literacy open-mindedness sophistication teaching anticipation canniness care carefulness caution circumspection clairvoyance discreetness discretion economy far-sightedness forethought long-sightedness precaution preconception premeditation prenotion prescience prospect providence provision prudence cognizance empathy enlightenment foresight query inquiry inquest poll wringer Q and A answer reply mystery problem debate dispute puzzle protest demur enigma dubiety calm point topic theme subject motion grill search challenge quiz interview seek examine knock hit roast inquire probe pump quest enquire solicit catechize pry petition go over ask about hit up sound out work over find surety oppose suspect hesitate impugn distrust mistrust suspicion impeach believe trust assignment avocation calling case circumstance concern duty employment episode event hap happening incident interest job mission obligation occupation occurrence office function proceeding profession project province pursuit question realm responsibility task thing transaction undertaking address adjuration application bid call claim demand entreaty imploration importunity invocation overture plea prayer proposal proposition recourse requisition solicitation submission suit supplication adjure advance apply ask beg beseech call upon contest crave entreat hit on implore importune plead pray propose refer require resort to strike submit sue supplicate urge agitate canvass clarify expostulate hold maintain reason remonstrate talk about affair beeswax carrying on function goings-on hanky-panky issue lookout matter palaver argue ask advice of be closeted with brainstorm call in cogitate collogue commune compare notes confab confabulate consider deliberate discuss flap groupthink huddle interrogate kick ideas around negotiate parlay pick one's brains powwow put heads together refer to regard respect review seek advice seek opinion of take a meeting take account of take counsel talk over toss ideas around treat turn to appeal business consult Questions Question Mayo mayo hospital infirmary sick bay dispensary academics advisers body clinic college corps department employees institute instructors lecturers literati mentors organization pedagogues personnel professorate professors profs researchers scholars society staff tutors university workers emergency room health service hospice institution nursing home rest home sanatorium sanitarium surgery ward academy association asylum business company conservatory establishment fixture foundation guild orphanage school seminar seminary system think tank shelter faculty Clinic noble large lofty august super rich fine regal superb unreal fab tiny paltry small common poor humble bad modest low main head chief grave mighty minor aesthetic creative cultivated cultured decorative dramatic elegant exquisite graceful grand harmonious ideal imaginative musical ornamental pictorial picturesque pleasing poetic refined rhythmical sensitive stimulating stylish sublime tasteful baronial brilliant eminent exalted glorious grandiose high-minded high-ranking highfalutin' honorable imposing impressive lordly magnificent majestic monumental pompous resplendent stately venerable alarming astonishing awe-inspiring awful beautiful breathtaking daunting dreadful fearful fearsome formidable frantic frightening hairy horrible horrifying intimidating mean mind-blowing moving nervous overwhelming real gone shocking something else striking stunning stupefying terrible terrifying wonderful wondrous zero cool admirable alluring angelic appealing beauteous bewitching charming classy comely cute dazzling delicate delightful divine enticing excellent fair fascinating foxy good-looking gorgeous handsome lovely marvelous nice pretty pulchritudinous radiant ravishing shapely sightly splendid statuesque symmetrical taking well-formed arch capital cardinal central champion consequential controlling crucial effective especial first foremost highest key leading major momentous number one outstanding paramount potent predominant preeminent premier primal primary prime principal ruling significant star stellar superior supreme telling uppermost vital weighty cool exemplary famous first-class first-rate five-star fly great groovy hunky-dory keen model neat nifty paragon peachy sup rior swell terrific artistic awesome dandy Grand Grands GRAND oval curved bowed looped arched spiral arced bent rotund curled ringed orbed coiled tiny small low soft weak entire full solid done whole part large fleshy plump chubby pudgy tubby thin frank blunt free vocal plain candid near around about almost just about most nearly roughly all but as good as close to exact hoop arc bend ring disk eye orb wheel band arch gyre curve orbit bow loop disc line series period course tour bout lap ambit level beat whirl turn stagnation shot load shell spin rotate girdle hem gird flank gyrate bypass pivot circle skirt roll begird form whorl slick sleek crook shape coil curl mold ruin back backward in reverse round encircling surrounding through throughout ammo armament ball bomb buckshot bullet cannonball cartridge charge chemical confetti explosive fuse grenade gunpowder iron rations materiel missile munition napalm powder rocket shrapnel torpedo acclaim acclamation accolade approbation big hand bring down the house cheering cheers commendation eulogizing hand hand-clapping hurrahs kudos laudation ovation plaudits praise rooting standing ovation crescent curvation curvature half-moon bridge camber extend hook hump hunch span stretch ammunition applause Rounds rounds Round Mayo Clinic Health care Healthcare Health Care health protection wellness program health care medical care primary care Health care Healthcare Health Care energy fitness verdure tone shape pink fettle stamina state vigor form bloom prime disease illness appearance aspect build constitution health kilter mint order phase repair status trim bliss dreamland ecstasy elation exaltation exhilaration exultation frenzy glee high spirits intoxication joy joyousness jubilation madness rapture relaxation transport good health robustness strength anatomy being condition figure frame object outline person phenomenon physique silhouette thing torso advantage big break blessing break fluke fortunateness godsend good luck happiness in the cards karma kismet luckiness lucky break occasion opportunity profit prosperity run of luck serendipity smile streak of luck stroke success triumph victory weal wealth win windfall agreement assurance covenant guarantee oath promise toast undertaking vow warrant word euphoria luck pledge Health HEALTH load strain fear worry charge woe dismay sorrow onus burden stress alarm sweat bother stew health aid relief joy delight calm benefit comfort help peace ease neglect effort wariness caution concern nicety interest exertion regard prudence trouble thought heed pains apathy laziness lethargy disregard ignorance omission oversight control trust keeping aegis ward watch tend protect attend sit mind foster mother nurse nurture wait on hate hurt enjoy love want cherish desire respect like prize take to amore ardor attachment care case closeness crush devotion emotion endearment feeling friendliness friendship good will hankering heart inclination itch kindness liking passion predilection propensity puppy love sentiment shine soft spot solicitude tenderness warmth weakness yen advancement advice advocacy alleviation allowance assist assistance attention backing backup benefaction benevolence bounty charity compensation cooperation deliverance encouragement endowment favor furtherance gift giving guidance hand handout leg up lift ministration ministry patronage promotion reinforcement rescue reward salvation service shot in the arm subsidy sustenance treatment all-overs angst ants in pants apprehension botheration butterflies cold sweat creeps disquiet disquietude distress doubt downer drag dread fidgets flap foreboding fretfulness fuss goose bumps heebie-jeebies jitters jumps misery misgiving mistrust nail-biting needles nervousness panic pins and needles restlessness shakes shivers suffering suspense uncertainty unease uneasiness watchfulness willies worriment amenity assiduities civility compliment consideration deference gallantry mindfulness politeness authority countenance influence sponsorship supervision affection anxiety attention(s) auspices Care cares care? feeling love soul nature pity zest gusto relish concern palate disdain apathy hatred dislike hate fear outside surface head nerve mind spirit spunk guts pluck will purpose moxie mettle bravery body core center focus middle root kernel gist hub bosom seat crux pith basic quick marrow nub margin border clock ticker amore ardor attachment care case closeness crush desire devotion emotion endearment friendliness friendship good will hankering heart inclination itch kindness liking passion predilection propensity puppy love regard sentiment shine soft spot solicitude tenderness warmth weakness yen courage determination firmness fortitude grit hardihood intestinal fortitude moral fiber resolution resolve stamina steadfastness tenacity toughness willpower authority backbone basis chief constituent essence essential evidence foundation fundamental groundwork important part infrastructure key origin primary element principal principle source underpinning antecedent assumption axiom background backing base bedrock cause chief ingredient data dictum explanation footing hard fact justification keynote keystone law nexus nucleus postulate premise presumption presupposition principal element proof reason rudiment sanction security substratum support theorem theory warrant birth conception egg embryo font fount fountain fountainhead generation genesis germ resource seed stem well argument burden discourse dissertation exposition material meat sense substance text thesis treatise upshot affection beginning Heart stent Stent PCI P.C.I. pci keen subtle intense sharp smart astute canny clever stupid honest blunt dull calm mild dense obtuse slow urgent severe sudden dire grave vital fierce kind peaked pointed spiked cuspate piked active acute alert athletic brisk buoyant bustling dexterous easy-moving energetic fleet frisky limber lithe lively mercurial prompt quick quick on the draw quick on the trigger quick-witted rapid ready spirited sportive spright sprightly spry stirring supple swift twinkle toes vigorous vivacious winged zippy Einstein advanced aware brainy brilliant clear-headed discerning eggheaded having smarts ingenious inventive knowing precocious whiz kid wide-awake accomplished bright expert genius gifted intellectual knowledgeable masterly penetrating profound talented whip clamant clamorous compelling critical crucial crying essential exigent imperative importunate instant pressing significant able adroit cagey careful cautious circumspect cunning discreet foxy frugal having fancy footwork hep intelligent judicious nimble-witted perspicacious prudent sagacious shrewd skillful slick slippery sly smooth street smart streetwise wary watchful wise with it worldly-wise climactical desperate paramount peak agile burning climactic cardiac arrest angina pectoris chest pains tachycardia cardiovascular disease congestive heart failure coronary coronary infarction coronary thrombosis myocardial infarction heart attack malady sign health ache bug complaint condition disease disorder dose flu illness indisposition infirmity syndrome affection ailment ill sickness upset association compound conglomerate ecosystem entanglement group network organization scheme structure synthesis system totality predicament problem temper weakness Cancer attack blight breakdown canker collapse contagion contamination convulsions debility decrepitude defect distemper endemic epidemic feebleness fever fit hemorrhage ill health infection inflammation misery pathosis plague seizure sickliness spell stroke temperature unhealthiness unsoundness virus visitation abuse affliction badness cruelty damage depravity destruction evil harm hurt injury insult malaise malice mischief pain suffering trial tribulation trouble unpleasantness wickedness woe wrong complex probe inquiry analysis inquest scrutiny quest probing delving R and D legwork ignorance explore consult analyze inquire look up do tests ignore audit checkup control investigation poll rein research review test burrow dig dredge examine excavate ferret out go into gouge out investigate jump into leave no stone unturned look into prospect ransack really get into rummage scoop out search seek shovel sift spade trowel turn inside out unearth bring to light come across come up with delve dig down expose extricate find retrieve root search high and low shake down turn upside down uncover examination exploration inquisition inspection interrogation query questioning study assay battery blue book breakdown canvass catechism checking cross-examination diagnosis dissection exam experiment final grilling make-up observation once-over oral perlustration perusal questionnaire quiz raid reconnaissance scan survey the eye third degree trial tryout view written appraise case check check out chew over consider criticize delve into dig into eye finger frisk go over go through gun inspect look over look see parse pat down peruse pick at ponder pore over prove read reconnoiter scope screen scrutinate scrutinize search into size up sweep take stock of try turn over vet weigh winnow enquiry Research oodles ream lots jumble total mint bunch cargo sum whole much hill hoard lump haul bundle plenty stack batch ocean mound load pot ton lot store stock bulk gobs bank volume mass clump a lot ditch debt one need want part abundance agglomeration aggregation amassment assemblage cluster collection concentration congeries deposit fullness gathering great deal harvest million mountain profusion quantity scad stockpile thousand trillion multiplicity jillion heap passel scads SCAD S.C.A.D.S gravidness gravidity abundance copiousness fecundity feracity fruitfulness generative capacity luxuriance plentifulness potency pregnancy productiveness productivity prolificacy prolificity puberty pubescence richness uberty virility evolution fecundation growth incubation maturation reproduction ripening accouchement birthing childbirth lying-in motherhood parturiency parturition travail prolificness fertility gestation childbearing Pregnancy Hormonal hormonal Collagen fault flaw lack glitch crack bug error injury seam kink catch second want scar check speck blot mark stain sin spot gap break knot hole foible rift vice blotch taint patch enough plenty blank boon good right truth line quit depart abscond revolt reject abandon desert spurn lapse schism leave turn rat rebel renege forsake go over run out come stay allow join beauty spot birthmark blackhead blister bloom blot on the landscape blur brand bruise chip cicatrix defacement defect deformity dent discoloration disfigurement disgrace dishonor eyesore freckle hickey imperfection impurity lentigo lump macula maculation mole nevus nodule pimple pock pockmark sight smudge snag speckle stigma tarnish wart whitehead zit black eye blemish odium onus slur smear breakdown computer malfunction failure hitch problem something wrong trouble absence default deficiency exiguousness famine inadequacy infrequency meagerness miss need paucity poverty privation rareness scantiness scantness shortage slim pickings sparsity uncommonness blunder dearth delinquency dereliction disregard insufficiency neglect nonpayment offense omission overlooking oversight shortcoming slight transgression weakness wrongdoing Defect chain regular rolling stopped halted abiding ceaseless confirmed constant continual continuing continuous deep-rooted deep-seated enduring ever-present fixed habitual inborn inbred incurable ineradicable ingrained inveterate lasting lifelong lingering long-lived long-standing obstinate perennial persistent persisting prolonged protracted recurrent recurring rooted routine settled stubborn sustained tenacious unabating unmitigated unyielding usual aeonian around-the-clock connected consecutive dateless endless eternal everlasting frequent interminable oft-repeated permanent perpetual relentless repeated repetitive running staying steady timeless unbroken unceasing unchanging unending unfailing unflagging uninterrupted unremitting unvarying unwaning circular patterned periodic seasonal bits and pieces broken capricious catchy changeable desultory disturbed erratic flickering fluctuating haphazard herky-jerky hit-or-miss impulsive inconstant intermittent interrupted on-again-off-again random restive restless shifting spasmodic spastic spotty unstable variable a good many commonplace customary everyday expected familiar general incessant iterated manifold many monotonous numberless numerous pleonastic profuse redundant reiterated reiterative successive thick ubiquitous various chronic cyclical fitful vascular develop devise produce design realize ponder form image feature fancy project purpose imagine spark cook up make up result ignore ruin end forget stop abort sketch detail paint relate state limn report sculpt hide portray term depict specify outline express name call recount label tell define recite picture impart expound draw trace narrate distort conceal listen obscure mystify mix up confuse cloud keep take behold conceive foresee grasp objectify predict regard see survey view vision visualize look upon think up phantom believe conjecture envision reckon suppose fantasize envisage infer guess think surmise dream up head trip spitball think likely trump up measure dislike hate neglect figure frame fantasy create scheme perceive plan fabricate invent harbor nurture think of break know read explain clarify solve enact comment render perform gloss decode adapt play gather mimic reenact make of fail direct echo typify embody follow show double glass copy mirror differ oppose reverse parody draft intend chart cast gauge get recognize apprehend catch discern pick up take in catch on get it mistake miss lose give act cover feel assume expect judge deem esteem sense hold credit reject doubt leave divine object reflect call up become pregnant brainstorm cogitate consider contrive depicture formulate meditate originate ruminate speculate characterize delineate illustrate interpret represent reproduce chronicle communicate construe convey image distinguish elucidate epitomize exemplify explicate illuminate make apparent make clear make sense of make vivid mark out particularize rehearse transmit write up anticipate conceptualize contemplate externalize form mental picture of have a picture of materialize view in mind's eye be inclined to think build castles in air conjure up see in one's mind describe curvity asymmetry sinuosity sinuousness tortuosity tortuousness unevenness crookedness cardiac arrest chest pains coronary tachycardia angina pectoris cardiovascular disease congestive heart failure coronary infarction coronary thrombosis myocardial infarction heart attack trunk case crate bin pyxis back heart breast bust bosom rib cage ribs thorax chest teats carton casket coffer pack package portmanteau receptacle front mammary glands mammilla nipple teat udder container corrugated box packet bag baggage basket box cabinet caddy caisson canister capsule cartridge casing chamber chassis compact cover covering crating crib drawer envelope folder grip holder integument jacket safe scabbard sheath shell suitcase tray wallet wrapper wrapping Chest cramp fever burn agony wound strain misery twinge ache injury spasm malady crick prick stitch throb gripe sting hurt tingle pang catch throe joy aid peace ease help cheer shock grief woe worry rack effort bother drag pest bore harm distress afflict agonize grieve rile torment vex gall suffer anguish injure convulse bite irritate nick irk smart annoy disquiet torture sadden punish inflame aggrieve harrow chafe stress chasten upset ail harass mend calm heal fix cure be sore pain pound beset burden crucify harry lacerate martyr oppress pester plague press smite strike trouble try adversity calamity cross crux depression difficulty disease disorder hardship illness infirmity misfortune ordeal plight scourge sickness sorrow suffering trial tribulation affliction aggro botheration exasperation hang-up headache irksomeness irritation pain in the neck pet peeve provocation teasing vexation bleed carry on disturb eat heart out excruciate labor lament sing the blues squirm stew over strive struggle take it badly wince writhe sicken aggravation Pain pain jerk burst throe access attack frenzy yank peace anguish hurt misery pang pounding smarting soreness spasm suffering throb throbbing twinge ailment bout breakdown convulsion disease failure fit illness paroxysm relapse seizure spell stroke agitation annoyance big scene big stink bother brawl brouhaha clamor confusion derangement disarrangement disorder disruption distraction eruption explosion ferment fisticuffs flap fracas fray fuss hindrance hubbub hullabaloo insurrection interruption intrusion molestation perturbation quake quarrel racket rampage restlessness riot ruckus rumble shock stink stir storm to-do tremor tumult turmoil upheaval uprising uproar violence blow caprice conniption epileptic attack humor jumps mood outbreak outburst rage rush spate tantrum torrent turn twitch whim whimsy aberration blow a fuse blow one's cork blow one's stack blow one's top craze delirium distemper dithers excitement fever flip one's lid free-for-all furor fury hell broke loose hysteria insanity lather lunacy madness mania passion row ruction rumpus stew transport wingding ejaculation peak ache disturbance orgasm s p a s m Spasm SPASM Spasm. anatomy operation autopsy necropsy mending sewing joining inquest study breakup review assay breakdown dissection dissolution division inquiry investigation partition reasoning resolution scrutiny search separation subdivision test analysis biology cytology diagnosis embryology etiology examination genetics histology medicine morphology physiology zoology pathological examination postmortem categorization classification detailed list itemization carving chip chop cleavage cleft fissure furrow gash graze groove intersection kerf laceration mark nick nip notch opening passage penetration pierce prick rabbet rent rip scarification sculpture section shave slash slit slot snip stab stroke trench trim wound audit battery blue book canvass catechism checking checkup cross-examination exam experiment exploration final grilling inquisition inspection interrogation legwork make-up observation once-over oral perlustration perusal probe quest questioning questionnaire quiz raid reconnaissance research scan survey the eye third degree trial tryout view written cut DISSECTION Dissection repair overhaul recovery harm hurt aid amendment amends assistance atonement balancing change conciliation correction cure ease indemnity justice offsetting payment quittance recompense rectification reestablishment reformation rehabilitation relief remedy remission remodeling renewal reparation reprisal requital restitution retribution return revision reward reworking satisfaction vengeance adjustment darn improvement mend new part patch reconstruction replacement substitution face-lifting overhauling refurbishment renovation slum clearance urban redevelopment acclimation adaptation awakening comeback metempsychosis reawakening reincarnation rejuvenation renaissance restoration revival alteration conversion regeneration remaking reorganization replanning resetting redress urban renewal readjustment rebirth D.R. Dr. Hayes hayes Haye
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