Understanding SCAD

Spontaneous coronary artery dissection (SCAD) is a rare but serious heart condition. It can happen when one of the blood vessels that brings oxygen to the heart develops a tear.

SCAD is different than a typical heart attack. With a typical heart attack, cholesterol and plaque buildup gradually. With SCAD, one of the layers of the heart’s artery tears suddenly. The flap from the tear can block blood flow, or blood can be trapped and cause a bulge that blocks blood flow.

SCAD may slow or stop blood flow to the heart, causing chest pain, heart attack or other life-threatening complications. 

SCAD mainly affects women, often those who are otherwise healthy and under age 50. Unlike many other heart problems, SCAD isn't linked to risk factors like high cholesterol, high blood pressure or diabetes. However, being pregnant or having some connective tissue conditions may increase your risk. 

SCAD can be treated with medication and certain procedures.

Causes of SCAD 

Experts don't know exactly what causes SCAD, but some factors can trigger the condition:

• Hormone fluctuations: The hormonal changes that happen during and after pregnancy may weaken the walls of the arteries and make them more likely to tear. 
• Physical stress: Strenuous exercise like weightlifting or extreme yoga poses or stressors like coughing or vomiting have been linked to SCAD. 
• Connective tissue disorders: Conditions like Marfan syndrome or Ehlers-Danlos syndrome may weaken the artery’s walls and make them more likely to tear. 
• Inflammatory conditions: Autoimmune diseases like lupus or multiple sclerosis or inflammation of the arteries (arteritis) may make SCAD more likely. That’s because chronic inflammation can weaken the artery walls over time.
• Migraines and emotional stress: Migraines may be linked to SCAD. And sudden stressful events or long-lasting periods of stress could also be triggers.
• Fibromuscular dysplasia: This condition causes blood vessels to narrow.

• Hypothyroidism (underactive thyroid): Not having enough thyroid hormone can increase your risk.

• Substance abuse: Using cocaine or other drugs may raise your risk of SCAD. 
• Uncontrolled hypertension: High blood pressure that’s not well managed puts strain on the blood vessel walls.

SCAD risk factors

Sometimes, SCAD happens without any known cause. But certain factors can increase your risk:

• Gender and age: SCAD can affect anyone, but it's most often found in women under age 50. Less than 10 percent of cases occur in males.
• A history of SCAD: If you’ve had SCAD in the past, you’re more likely to have it again. 
• Genetics: Your risk may be higher if you have a family history of SCAD.
• Tobacco use: Smoking or using tobacco products increases your risk.
• Having recently given birth: During the weeks after childbirth (the postpartum period), you are at higher risk for SCAD.

Symptoms of SCAD

If you have symptoms of SCAD, call 911 to get emergency medical care right away. Don’t drive yourself to the hospital. 

Symptoms aren’t always the same in everyone. But symptoms of SCAD include:

• Chest pain or pressure that may be sudden and severe. It may strike in the chest or upper back and radiate to the arms, neck or jaw.
• Shortness of breath, since the heart may not get enough blood. This may happen even without chest pain.
• Rapid heartbeat (tachycardia) or heart palpitations, which can cause dizziness or lightheadedness.
• Fainting.
• Sweating, especially when chest pain is occurring. 
• Nausea and vomiting.
• Headache.
• Feeling extremely tired.

The symptoms of SCAD are similar to the symptoms of a typical heart attack. However, these signs can point to SCAD rather than a heart attack:

• Age and gender: SCAD is more common in women under age 50, who are less likely to have risk factors like high cholesterol or high blood pressure.
• Lack of atherosclerosis: SCAD isn’t caused by plaque buildup in the arteries. 
• Sudden onset of symptoms: Heart attacks are more likely to get worse gradually, while SCAD symptoms strike quickly. SCAD symptoms are also more likely to vary in intensity.
• Normal cardiac enzymes: The cardiac enzymes that are usually high during a heart attack are often normal with SCAD.
• Spontaneous healing: Sometimes, SCAD gets better without treatment. Heart attacks usually cause some long-lasting damage. 

Diagnosing SCAD 

If you have symptoms of SCAD, it’s important to get medical care right away — call 911. That way, health care providers can start with diagnostic testing and come up with a treatment plan that’s right for you.

SCAD can lead to serious complications such as heart attacks and arrhythmias. Getting care quickly can help reduce your risk of these problems and minimize harm to the heart muscle.

Your provider may recommend:

• Electrocardiogram (ECG), which measures the heart’s electrical signals to look for problems.
• Coronary angiography, which can show the blood vessels and see if there are signs of a tear. Within the coronary angiography, your provider may utilize:
  • Intravascular ultrasound (IVUS), which creates images of the inside of blood vessels. 
  • Optical coherence tomography (OCT), which is similar to IVUS but uses light waves to create images. 
• Cardiac magnetic resonance imaging (MRI), which can show blood flow, heart function and abnormalities.
• Blood tests to look for a cardiac marker called troponin which may appear in your blood if your heart has been damaged. Blood tests can also help determine how healthy the heart is and rule out other conditions that could be causing symptoms.

Treatment for SCAD

Your health care team will work with you to come up with the best treatment plan. They will consider how serious your condition is, whether you have any complications and how healthy you are overall. SCAD patients are usually treated with medication and certain procedures.

Medication

• Nitroglycerin or other medications that open your blood vessels may reduce chest pain and improve blood flow.
• Pain relievers such as acetaminophen may help manage discomfort.
• Aspirin may help prevent blood clots from forming.
• Blood thinners (anticoagulants) like heparin may reduce the risk of clotting.
• Medications to control blood pressure, such as beta-blockers or ACE inhibitors, may help regulate the heart rate and reduce your heart’s workload.

It’s important to take your medication as recommended. Talk to your provider if you have any concerns or notice any side effects.

Procedures

You might not need a procedure to treat SCAD. In about 75% of cases, close monitoring, lifestyle changes and medication can manage it. 

If you need additional treatment, your doctor might recommend:

• Coronary angiography and stenting: If SCAD is causing a lot of blockage, you may need angiography. That’s where your health care provider uses a special dye injected into your blood to locate the blockage. Once they know exactly where the blockage is, they can place a stent, which is a small mesh tube that can help keep your blood vessel open. This procedure can improve blood flow and help you heal.
• Implanted defibrillator: This device monitors your heart rhythm and can restore the correct heartbeat if it detects any problems. 
• Coronary artery bypass grafting (CABG): In severe cases where SCAD affects several arteries, or if other interventions aren’t options, you may need CABG. This procedure involves using blood vessels from other parts of your body to reroute the blood around blocked arteries. 

Recovering from SCAD

If you’ve had SCAD, your health care provider will want to see you at regular follow-up appointments to make sure you’re doing well and that your treatments are working. 

They may recommend imaging studies like angiography or cardiac MRI to see how your arteries are healing and to make sure the artery walls are stable. 

They may also suggest cardiac rehab, which is a supervised program that includes exercise, education and emotional support.

You may also want to connect with support groups or a mental health provider for help coping with the stress and anxiety of SCAD.

Living with SCAD

After a SCAD diagnosis, you’ll want to care for yourself physically and emotionally. If you’ve had SCAD, you’re at higher risk of having it again. A repeat episode could happen soon after the first one, or many years later.

Taking these steps can help lower your risk:

• Educate yourself about SCAD. When you understand the condition, treatment options and research, you can advocate for your health.
• Take your medication as directed.
• Choose a heart-healthy diet rich in fruits, vegetables, whole grains and lean proteins. Limit saturated fats, trans fats and sodium.
• Talk to your provider about family planning. Pregnancy may not be safe if you’ve had SCAD. 
• Get regular physical activity. Talk to your health care team about the best way to exercise, based on your condition and capabilities. Limit intense exercise unless a provider says it’s okay.
• Quit smoking.
• Limit alcohol.
• Manage stress with techniques like mindfulness, meditation, relaxation exercises and other stress-reducing activities.
• Prioritize good sleep by sticking to a regular routine and keeping your bedroom cool, dark and quiet.
• See your provider regularly to check your heart health and monitor cardiac risk factors such as blood pressure, cholesterol and blood sugar.
• Build a support network of family, friends and health care providers. They can support your emotional well-being and your recovery.
• Consider genetic counseling if you have a family history of SCAD.