I had a call the other day, 40s female with 7/10 central chest pressure radiating to her left arm, under left breast. PT said that how she felt now is identical to how she felt a few years ago; she had SCAD as in sudden coronary arterial dissection then and had stents put in. How does ASA and nitro play a role in this case, because it sounds textbook ischemic but with such a rare and bizarre medical history. Please let me know what you think? 

The symptoms are in keeping with myocardial ischemia, likely secondary to the SCAD.   As per the directive, SCAD is not a contraindication to ASA administration.  The use of ASA in this patient would not cause any harm and in fact, is often used as part of the ongoing treatment.  Thrombolytic treatment would be avoided in these patients once they arrive in the ED.  Nitroglycerin can be used to treat the ischemia given SCAD is not a contraindication to its use. 

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ASA, BHP Patch, Cardiac Ischemia, Chest pain, SCAD

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