This handout is for stemi from spontaneous coronary artery dissection (scad). Your care team identified this based on: peripartum / postpartum woman with ischemic chest pain + st elevation — high scad probability.
Other reasons your team may use this plan: coronary angiogram showing yip-saw type 1 (contrast staining + multiple radiolucent lumens), type 2 (long diffuse smooth stenosis), or type 3 (focal stenosis mimicking atherosclerosis) → scad; patient with known fmd, ehlers-danlos, marfan, or loeys-dietz presenting with stemi — pre-test probability of scad high.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| aspirin | 81 mg daily (no load if conservative) OR 162-325 mg load if PCI | PO | daily indefinitely if no PCI; daily × 12 mo per ACS protocol if PCI | ESC 2018 SCAD position (PMID 30033129) — single antiplatelet sufficient for most; ASA continued indefinitely per Mayo SCAD registry consensus |
| carvedilol | 3.125 mg BID titrate to max tolerated | PO | BID indefinitely | ESC 2018 SCAD position (PMID 30033129) — BB reduce wall stress + may reduce recurrence; observational data only |
| clopidogrel | 300 mg load → 75 mg daily | PO | daily × duration determined case-by-case | Add P2Y12 only if PCI performed (mandatory DAPT post-stent) OR intracoronary thrombus on imaging; clopidogrel preferred over ticagrelor in SCAD due to lower bleeding extension risk |
| unfractionated heparin | 70-100 U/kg IV bolus, NOT continued post-cath in conservative SCAD | IV | bolus only at PCI; discontinue post-procedure | AHA 2025 ACS Class I for PCI; in SCAD specifically, AC NOT continued post-procedure to avoid hematoma extension |
| atorvastatin | 40-80 mg daily | PO | daily | NOT routinely indicated in SCAD (no plaque rupture); reserve for patients with concomitant ASCVD or 2018 ACC/AHA guideline-meeting LDL — different from atherosclerotic STEMI default |
| lisinopril | 2.5-5 mg daily titrate | PO | daily | GDMT initiation per ACC/AHA 2022 HF Class I if LVEF reduced post-SCAD-MI; otherwise not routinely needed |
Plan: SCAD conservative-first regimen — overrides parent cardio.stemi.core.v1 DAPT default; uses single antiplatelet + BB; PCI/AC reserved for instability
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
FMD screening (renal + cerebrovascular CTA / MRA); contraception counseling (avoid pregnancy if recent SCAD; relative contraindication for ~12 months post-SCAD); cardiac rehab (low-intensity); genetics referral if connective-tissue disorder suspected; psychosocial support (recurrence anxiety is common)
Guideline: ESC 2018 SCAD position paper + Hayes 2018 ACC SCAD scientific statement + 2025 ACC/AHA ACS Guideline + Mayo Clinic SCAD registry