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Spontaneous Coronary Artery Dissection

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What Is Spontaneous Coronary Artery Dissection (SCAD)?

The coronary arteries are the vessels that supply blood and oxygen to your heart muscle. A tear or dissection that forms in the vessel wall causes SCAD.

When a tear causes the inner layers of the artery to separate from the outer layers, blood can pool between the layers. This pool of blood outside the blood vessels is a hematoma.

As the hematoma gets larger, it can block normal blood flow to the coronary arteries and cause symptoms of a heart attack.

SCAD is an emergency condition that requires immediate diagnosis and treatment.

While most people aren't at risk of SCAD, it's the most common cause of heart attack in women in their 40s-50s.

Researchers don't know exactly how many women have the condition because of under diagnosis in the past.

Now, more women are receiving a diagnosis due to advances in testing for SCAD.

Hospitals also have registries to increase both doctor and patient awareness and to learn more about the disease. Ask your doctor about these registries to help you connect with others who have SCAD.

SCAD complications

Because the blood pools and can clot within the vessel wall, SCAD reduces or blocks blood flow to the heart.

This can lead to:

  • Heart attack.
  • Heart rhythm problems.
  • Even sudden death.

SCAD causes and risk factors

Doctors and researchers haven't learned the exact cause of SCAD. Many women with SCAD don't have common risk factors for heart disease, such as high cholesterol or diabetes.

But they have found some factors that increase your risk:

  • Female sex. SCAD can occur in men, but it's much more common in women.
  • High blood pressure. People with very high or uncontrolled blood pressure are at risk of SCAD. They're also at higher risk for SCAD to return.
  • Childbirth. Though rare, SCAD is among the most common cause of heart conditions for women in the first few weeks following delivery.
  • Underlying blood vessel condition. Fibromuscular dysplasia is a condition that causes abnormalities in arteries that supply blood and oxygen to many organs, including the heart. People with this condition are at higher risk for SCAD because it weakens the artery walls and can cause them to tear.
  • Autoimmune diseases. Conditions like Lupus can cause inflammation in blood vessels. Polyarteritis nodosa is another immune system disease that can affect the arteries. These conditions may increase the risk for SCAD.
  • Inherited connective tissue disease. Ehlers-Danlos syndrome and Marfan syndrome have some link to SCAD. These diseases can affect blood vessels including the coronary arteries, causing them to weaken or stretch. This makes them more prone to tears.
  • Intense exercise or severe emotional stress can trigger tears in people who have blood vessels prone to SCAD.

Why choose Magee-Women's Heart Program?

At the Magee-Women's Heart Program, we:

  • Have experts who specialize in heart conditions that disproportionately affect women, including SCAD.
  • Can help connect you to others who have SCAD or take part in research to learn more about this condition.
  • Provide heart care across all stages of a woman's life, including pregnancy.

SCAD Symptoms and Diagnosis

SCAD causes heart attack symptoms. Women who have these symptoms should seek care right away, even if they don't have heart attack risk factors.

Symptoms include one or many of the following:

  • Chest pain or discomfort.
  • Pain in the arms, jaw, or shoulder.
  • Shortness of breath.
  • Fast heartbeat.
  • Sweating.
  • Nausea.

Diagnosing SCAD

To diagnose SCAD, your doctor uses imaging tests similar to diagnosing other types of heart attacks.

  • Coronary angiogram. A doctor inserts a catheter into an artery in the leg or arm and passes it up to the heart's arteries. Continuous x-rays then make short films of the arteries to look for tears or blood pooling in the vessels.
  • Intravascular ultrasound. During an angiogram, the doctor also inserts imaging wires in the catheter. These wires use sound waves to take pictures inside of the arteries to look closer for tears or blood pooling.
  • CT scan. This type of imaging test helps look closely at the arteries in the heart. It also looks for issues in other arteries, such as those in the kidneys or brain.

SCAD Treatment.

The goal of SCAD treatment is to make sure there's constant normal blood flow to the heart.

If you have heart attack symptoms, go to the ER right away.

You may need to stay in the hospital. This is so we can give you medicine to help ease your symptoms and observe you for complications of SCAD.

The blood clot will often heal without surgery or further invasive treatments.

After diagnosis, your doctor will decide the best SCAD treatment for you.

Medicine to treat SCAD

Your doctor may prescribe drugs to treat SCAD or control symptoms, such as:

  • High blood pressure or high cholesterol medicine.
  • Deta-blockers to reduce stress on the blood vessels in the heart.
  • Aspirin or blood thinners.
  • Nitrates or calcium channel blockers to relieve chest pain or other symptoms.

Stent placement to treat SCAD

Your doctor may want to place a stent if SCAD severely impedes blood flow or if drugs don't control your symptoms.

The stent is a small mesh tube that lets blood flow through the artery normally.

This treatment is much like a coronary angiogram that diagnoses SCAD. Your doctor inserts a catheter through an artery in your wrist or leg to place a stent in the coronary artery.

Coronary bypass surgery for SCAD

This surgery uses a blood vessel from another part of the body to divert blood away from the damaged vessel.

You may need this surgery if your doctor:

  • Finds several tears in the coronary arteries.
  • Can't treat the tear with medicine or a stent.

SCAD treatment recovery

After diagnosis and treatment, you may spend a few days in the hospital. This is to make sure the vessel tear doesn't get worse and cause complications.

You can expect a longer stay if you need a stent or bypass surgery.

Your doctor may prescribe cardiac rehab after you leave the hospital. This supervised exercise helps you feel safe and build strength to get back to your normal activity.

SCAD can happen again, particularly after childbirth or when entering menopause.

At Magee-Women's Heart Program, our experts work closely with specialized obstetricians to take care of you before, during, and after pregnancy.