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Spontaneous Coronary Artery Dissection (SCAD)

Spontaneous Coronary Artery Dissection (SCAD) is a tear or dissection that forms in the coronary artery wall. SCAD is an emergency condition that requires immediate diagnosis and treatment.

The coronary arteries supply blood and oxygen to the heart muscle. When a tear causes the inner layers of the artery to separate from the outer layers, blood can pool between the layers. As the blood pool gets larger, it can block normal blood flow to the coronary arteries and cause heart attack symptoms.

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

UPMC offers expert treatment for SCAD, including medications, stenting, or coronary artery bypass graft (CABG) surgery.

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What Is Spontaneous Coronary Artery Dissection (SCAD)?

SCAD is an emergency condition that requires immediate diagnosis and treatment. SCAD occurs without warning and can lead to serious complications, including heart attack and death.

SCAD occurs when the coronary arteries, which supply blood and oxygen to your heart muscle, have a tear or dissection.

When the 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.

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

This can lead to:

How common is SCAD?

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

SCAD is the cause of about 25 percent of heart attacks in women under age 60 and is the leading cause of pregnancy-associated heart attacks.

What causes SCAD?

Doctors and researchers haven't learned the exact cause of SCAD. People who develop SCAD often do not have any risk factors for cardiac disease.

What are SCAD risk factors and complications?

SCAD risk factors

Researchers have identified certain factors that may increase your risk of SCAD:

  • 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.
  • Childbirth – Though rare, SCAD is among the most common causes of heart conditions for women in the first few weeks following delivery.
  • Gender – SCAD can occur in men but is 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.
  • 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 – This can trigger tears in people who have blood vessels prone to SCAD.
  • Underlying blood vessel disorders – Fibromuscular dysplasia 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.

Complications of SCAD

Left undiagnosed or untreated, SCAD can lead to heart attack and even death.

Does SCAD damage the heart?

Undiagnosed and untreated, SCAD can damage the heart muscle and affect heart rhythm.

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What are the Signs and Symptoms of SCAD?

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

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How Do You Diagnose SCAD?

Your doctor uses the same imaging tests to diagnose SCAD as those used to diagnose other types of heart attacks, including:

  • 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.
  • CT scan – This type of imaging test helps examine the arteries in the heart closely and looks for issues in other arteries, such as those in the kidneys or brain.
  • 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 for tears or blood pooling.

What is the survival rate for patients with SCAD?

SCAD is a dangerous condition that must be treated as an emergency. However, most patients live healthy lives after being treated for SCAD.

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How Do You Treat SCAD?

The goal of SCAD treatment is to ensure constant normal blood flow to the heart. Medications are often enough to restore blood flow to the heart. Most people who develop SCAD improve with medications that manage blood pressure, high cholesterol, and blood clots.

You may need to stay in the hospital while you are treated so your doctors can make sure you don’t develop any complications.

The blood clot will often heal without surgery or further invasive treatments. After diagnosis, your doctor will recommend the best SCAD treatment for you.

Medicine to treat SCAD

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

  • Aspirin or blood thinners.
  • Beta-blockers to reduce stress on the blood vessels in the heart.
  • High blood pressure or high cholesterol medicine.
  • 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 holds you artery open and lets blood flow through 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 artery bypass graft (CABG) 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:

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

What happens after treatment for SCAD?

After diagnosis and treatment, you may spend a few days in the hospital. This is to make sure your vessel tear doesn't worsen 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 so you can return to your normal activities.

It’s important to know that SCAD can happen again, particularly after childbirth or when entering menopause. You may need to take precautions or have ongoing follow-up care at these stages of your life.

By UPMC Editorial Staff. Last reviewed on 2024-10-01.