Cardiology Team Assessment

Possible further investigations considered for Rebecca:

Cholesterol: It is important to establish Rebecca’s full cardiovascular risk profile. Cholesterol can be checked but the link between cholesterol level and SCAD is not clear. Cholesterol should be treated according to an overall total CVD risk. 

• • Rebecca’s cholesterol was checked and is found to be within normal limits.
  • For more information about cholesterol visit CHSS Resources Hub: Cholesterol

Echocardiogram (Echo): A method of studying the heart’s structure and function by using ultrasound. It checks the structure of the heart and surrounding blood vessels, analysing how blood flows through them, and assesses the pumping chambers of the heart. It can show if the heart has become enlarged or is working under strain.

• • Results of Rebecca’s echo were normal.
  • For more information on Echocardiogram visit: NHS Inform 
  • Please note that Rebecca had an electrocardiogram (ECG) when she was first admitted to the emergency department and if she is still having chest pain the cardiology team may request to repeat the ECG. For more information on ECG visit: NHS Inform

Head to hip Computed Tomography Angiography (CTA): This is an x-ray technique that uses a computer to create cross-sectional images of the body. It is particularly useful in cardiology for visualising blood vessels such as the aorta.  A CTA allows identification of other arterial abnormalities and aneurysms (a bulging, weakened area in the wall of blood vessel) e.g. fibro muscular dysplasia (FMD). FMD is the abnormal development or growth of cells in the walls of arteries that can cause the blood vessels to narrow or bulge.

• • Rebecca’s results show no further concerns, other than the initial SCAD diagnosis.
  • For more information on CT Angiography visit: NHS UK

X-rays: An x-ray is used to generate images of tissues and structures inside the body.

• The cardiology team agree it is not necessary for Rebecca to have a chest x-ray, particularly if an echocardiogram has been done.
• For more information on x-rays visit: NHS UK

Oestrogen, and progesterone levels: Blood tests are carried out to check these levels. However, it is not standard practice to check.

• Although Rebecca is not reporting symptoms indicative of being perimenopausal SCAD can develop around the perimenopause age.
• Her blood tests show her oestrogen and progesterone levels do not indicate she is menopausal.   
• For more information on perimenopause visit: NHS UK

Exercise tolerance test (ETT): Records the activity of the heart as it works harder, for example while you’re walking on a treadmill. This “exercise” ECG records how the heart responds to exercise.

• It is not necessary for Rebecca to have an ETT as it is not standard practice and exercise is believed to be safe in people with SCAD.
• For more information on ETT visit: NHS Inform

Quality of life/psychological screening (e.g. Patient Health Questionnaire-9 [PHQ-9]): Psychological distress is common in people with SCAD, so an assessment tool such as the Patient Health Questionnaire-9 (PHQ-9) can be useful in assessing Rebecca’s current psychological health/state.

• Results of the assessment can be used as a screening tool for potential onward referral for psychological input if necessary and if Rebecca agrees.
• It is identified through the PHQ-9 that Rebecca has a very stressful job.  
• For more information on PHQ-9 psychological assessment tool visit: Patient Health Questionnaire (PHQ) Screeners. Free Download | phqscreeners 

Screen for connective tissue disorders: Some connective tissue disorders are linked to increased risk of CVD and SCAD. These include Fibromuscular Dysplasia, Marfan Syndrome, Osteogenesis Imperfecta and type IV Ehlers-Danlos Syndrome.

• Rebecca’s results show no issues with connective tissue disorders.  
• For more information on connective tissue disorders visit: Healthcare Improvement Scotland