What is spontaneous coronary artery dissection?
Spontaneous Coronary Artery Dissection (SCAD) is a tear in an artery wall in your heart that allows blood to build up in the space between the layers of your artery wall. This leads to a reduction or blockage of blood flow to your heart, which causes damage to your heart muscle and affects your heart rhythm. Reduced blood flow could cause a heart attack or cardiac arrest (cardiopulmonary arrest).
Who is at risk?
Ninety percent of SCAD cases are women, mostly between 30- 60 years old. SCAD accounts for about 25% of all heart attacks in women under 60 years old.
Other risk factors include:
- fibromuscular dysplasia (FMD)
- connective tissue disorders
- systemic inflammations
- cocaine use
- severe emotional stress
- intense physical exertion
- hormonal therapy with estrogen & progesterone
Pregnant and post-partum women are also at risk of SCAD. The strain of pregnancy and labour can add to the stress on weaker blood vessels, leading to a tear. P-SCAD is a very rare pregnancy-associated SCAD that could lead to a heart attack if not treated as soon as symptoms appear.
Causes
The cause of SCAD is still unknown. It is believed that it starts with your artery wall weakening. Possible causes of weakened artery walls are:
- fibromuscular dysplasia
- genetics
- multiple pregnancies
- connective tissue disorders
- systemic inflammations (like Crohn’s disease)
- hormonal changes/therapy
- cocaine use
SCAD can also be triggered by highly emotional events (death of loved one, job loss, breakdown of marriage) or physical stresses (giving birth, weight lifting, intensive workout, straining bowel movement, coughing, retching/vomiting,). In a recent study, more than half of patients experienced an emotionally or physically stressful event around the time of their SCAD.
Symptoms
If you experience a SCAD episode you may have these symptoms:
- chest pain, pressure, tightness or heaviness
- rapid heartbeat, fluttery feeling
- pain in arms, shoulders, jaw, neck, back or stomach
- excessive sweating
- unusual/extreme exhaustion
- nausea, vomiting
- dizziness/lightheadedness
- fainting/loss of consciousness
- headache
Diagnosis
SCAD is not widely understood and is often misdiagnosed. First, an echocardiogram will be done to check your heart activity. A doctor will also look to see if you have elevated troponin levels in your blood. This is a protein found following damage to your heart.
An imaging test called coronary angiogram will give your doctor an idea of the location of the tear and its measurements. If you are pregnant this test may not be safe for the fetus. Sometimes, further imaging with optical coherence tomography (OCT) or an intravascular ultrasound (IVUS) may be necessary to help diagnosis.
Your doctor may also perform a multidetector computed tomography scan (MDCT) to provide a detailed image of your heart.
Treatment
Managing SCAD will depend on the location and length of your tear and the damage done to your artery, with the hope that your artery will heal itself. SCAD treatment is usually conservative because surgery and aggressive treatments can be high risk. Treatment options may include:
Sometime after four to six weeks, another angiogram may help your healthcare team to understand if anything else needs to be done. SCAD recurrences are common (20%) so you should have frequent check-ups with your doctor. It is usually recommended that you take ASA (Aspirin) and beta-blockers long-term to help manage your heart health.
Surgery and other procedures
Sometimes medications and lifestyle changes may not work for you and surgery is needed. This could happen if the tear is too extensive or is near an important part of the heart. If you continue to have symptoms or remain unstable you may also need one of these procedures:
- angioplasty/ percutaneous coronary intervention (PCI)
- implanted defibrillator
- coronary artery bypass grafting (CABG)
Lifestyle and ongoing care
Lifestyle changes that may prevent SCAD from recurring include:
- avoiding emotional stress
- regular exercise, without intense weight lifting or competitive sports
- achieving a healthy weight and diet to manage blood pressure
- pregnancy might be discouraged because of the risk of peripartum SCAD or P-SCAD
- cardiac rehabilitation
Living with SCAD
It’s normal to feel worried or afraid after a diagnosis of heart disease. Find someone you can turn to for emotional support like a family member, friend, doctor, mental health worker or support group. Talking about your challenges and feelings could be an important part of your journey to recovery.
There are support groups and online communities you can join to help you cope with the effects of SCAD and connect with other survivors:
- Heart & Stroke – Community of Survivors
- SCAD Research Inc – Support and additional information
- Women Heart: The National Coalition for Women with Heart Disease - Online Community for Women with Heart Disease
- SCAD Alliance – Resources including peer support and clinical studies
Sudi’s experience with SCAD made her an advocate for more accurate diagnosis
Research
Research is underway to better understand SCAD and to develop new treatments.
A Heart and Stroke funded SCAD study will look at the connection between SCAD and genetics. It aims to advance women’s heart health by learning more about potential genetic markers that could indicate SCAD.
There is another study underway that will look at the connection between SCAD and medical conditions that result in changes to the arteries. This study hopes to improve the diagnosis of SCAD and help doctors better understand related conditions. Learn more about this exciting Canadian SCAD study here.
