Spontaneous Coronary Artery Dissection

A sudden tear in a heart artery, called spontaneous coronary artery dissection (SCAD), is a serious medical emergency. This tear can restrict or stop blood flow to the heart, potentially leading to a heart attack, irregular heartbeat (arrhythmia), or even sudden death. While SCAD is most frequently diagnosed in women between the ages of 40 and 50, it can happen to anyone, including men, at any age. Importantly, people with SCAD often don't have other typical risk factors for heart disease, like high blood pressure, high cholesterol, or diabetes. This means it can affect seemingly healthy individuals. Prompt medical attention is crucial because untreated SCAD can be life-threatening. If you experience chest pain, shortness of breath, or other symptoms that could indicate a heart attack, seek immediate emergency medical help, even if you don't think you're at risk.

Sudden cardiac arrest (SCAD) can cause various symptoms. These include:

• Chest pain or tightness: This might feel like pressure in your chest.
• Pain spreading to other areas: The pain can also travel to your arms, shoulders, back, or jaw.
• Difficulty breathing: You might feel short of breath or have trouble catching your breath.
• Unexpected sweating: This could be a sudden, heavy sweat.
• Extreme fatigue: You might feel unusually tired or drained.
• Upset stomach: This can include nausea or other stomach discomfort.
• Fast or irregular heartbeat: Your heart might beat faster than usual, or you might feel a fluttering sensation in your chest.
• Dizziness: You might feel lightheaded or unsteady.

If you experience any of these symptoms, especially chest pain, it's crucial to seek immediate medical attention. Call 911 or your local emergency number right away. If possible, have someone drive you to the nearest hospital. Avoid driving yourself unless absolutely necessary. Prompt medical care is vital in these situations.

If you're experiencing chest pain or think you might be having a heart attack, call 911 or your local emergency number immediately. This is crucial because a heart attack is a serious medical emergency. If you can't call 911 or don't have access to emergency medical services right away, have someone else drive you to the nearest hospital. It's best not to drive yourself unless absolutely necessary. Driving while experiencing chest pain could be dangerous for you and others on the road. If you're unsure, err on the side of caution and get help immediately.

Doctors don't know what causes spontaneous coronary artery dissection. Spontaneous coronary artery dissection (SCAD) is a condition where a tear or split forms in one of the arteries that supply blood to the heart. This can happen unexpectedly, without any obvious reason or major physical event. The exact reason why this happens is still being researched.

Sudden cardiac arrest (SCAD) can happen to anyone, but certain factors increase the chances. Understanding these risks can help people take steps to protect their health.

Gender: While SCAD can affect anyone, women are more likely to experience it than men.

Pregnancy and Childbirth: Some women who experience SCAD have recently given birth. The hormonal changes and stress of childbirth can put extra strain on the blood vessels, potentially triggering SCAD, especially in the weeks following delivery, but it can also happen during pregnancy.

Stress: Intense physical activity or severe emotional distress can raise the risk of SCAD. The body's reaction to these stressful events might contribute to the condition.

Fibromuscular Dysplasia (FMD): This condition weakens medium-sized arteries, making them more vulnerable to problems like aneurysms or tears (dissections). Women are more prone to FMD than men, and this increased risk also correlates with a higher chance of SCAD.

Genetic Conditions: Certain genetic conditions affecting connective tissue, such as Ehlers-Danlos and Marfan syndromes, have been linked to SCAD. These conditions can affect the strength and elasticity of blood vessels, increasing the risk of damage.

High Blood Pressure: Very high blood pressure puts extra pressure on blood vessels, increasing the risk of SCAD. Managing blood pressure is crucial for overall cardiovascular health.

Illegal Drug Use: Using cocaine or other illegal drugs can harm the heart and blood vessels, potentially increasing the risk of SCAD. These drugs can cause significant stress on the cardiovascular system.

It's important to remember that having one or more of these risk factors doesn't guarantee that someone will experience SCAD. However, understanding these factors can help individuals and healthcare providers identify potential risks and take preventive measures. Always consult with a doctor for personalized health advice.

Sometimes, a condition called SCAD (Spontaneous Coronary Artery Disruption) can lead to a heart attack. SCAD happens when blood flow through an artery is reduced or blocked. This can weaken the heart muscle, increasing the risk of a heart attack.

Importantly, a heart attack from SCAD is different from a heart attack caused by a buildup of fatty substances (like cholesterol) in the artery walls, a condition called atherosclerosis. In SCAD, the inner and outer layers of the artery can split, allowing blood to pool between them. This pooling blood can put extra pressure on the artery, making the problem worse.

Even if treated successfully, SCAD can recur. This means it can happen again, either shortly after the first event or even years later. People who experience SCAD may also be more likely to develop other heart problems, such as heart failure, due to the damage caused by the heart attack.

Sudden Coronary Artery Dissection (SCAD) Diagnosis and Testing

SCAD is often diagnosed in an emergency situation. Doctors will typically start by asking about your medical history, both personal and family. This helps them understand any potential risk factors. They'll then perform various tests to check your heart's health and function.

Heart Tests Used to Diagnose SCAD

These tests are similar to those used to diagnose a heart attack.

• Blood Tests: After a heart attack, certain proteins leak into the bloodstream. Blood tests can look for these proteins, indicating potential heart damage. Other blood tests might also be done to assess overall health.

• Electrocardiogram (ECG or EKG): This quick test measures the electrical activity of your heart. It shows how fast or slow your heart is beating and can detect signs of a heart attack. Small sticky patches (electrodes) are placed on your chest, and sometimes your arms and legs.

• Cardiac Catheterization: A thin, flexible tube (catheter) is inserted into a blood vessel, usually in your wrist (radial artery) or groin (femoral artery). The catheter is guided to your heart. This procedure allows doctors to examine the heart's structure and function.

• Coronary Angiogram: A type of cardiac catheterization, a coronary angiogram is used to view the coronary arteries (the blood vessels that supply the heart). A catheter is inserted into an artery in your groin, arm, or neck and guided to your heart. Dye is injected through the catheter to make the arteries show up clearly on images. This helps identify blocked or narrowed arteries, which can indicate SCAD.

• Additional Tests During a Coronary Angiogram: In some cases, further tests are performed during the angiogram to confirm the diagnosis and plan treatment. These tests include:

  • Optical Coherence Tomography (OCT): This test uses light to create detailed images of the blood vessel walls. A catheter is inserted, and a light beam shines through to view the inside of the arteries. This can help pinpoint the cause of heart problems, including SCAD.

  • Intravascular Ultrasound (IVUS): This test uses sound waves to create images of the inside of the coronary arteries. A catheter with a sound-emitting device is inserted into a blood vessel and guided to the heart. The sound waves bounce back, and a computer converts them into images of the artery walls. This provides a detailed view of the arteries, helping in the diagnosis of SCAD.

Understanding Twisted Arteries (Tortuous Arteries):

Sometimes, the coronary arteries can be twisted or unusually shaped (called tortuous). This can be part of the SCAD condition. The coronary angiogram can help identify these unusual shapes.

Mayo Clinic Care:

Mayo Clinic has experienced specialists who can provide comprehensive care for those with SCAD. They offer various diagnostic and treatment options to help manage the condition effectively.

Spontaneous Coronary Artery Dissection (SCAD) Treatment Explained

SCAD is a condition where a tear forms in an artery of the heart. This tear can reduce blood flow to the heart, causing chest pain and other symptoms. The goal of treatment is to restore proper blood flow, manage pain, and prevent future occurrences.

How is SCAD Treated?

Treatment for SCAD depends on several factors, including the severity of the tear, the patient's overall health, and the location of the tear. There are a few main approaches:

1. Medications:

Many people with SCAD only need medications to manage symptoms and prevent future problems. These might include:

• Aspirin: Taking aspirin regularly can help lower the risk of heart disease after SCAD. Talk to your doctor about whether daily aspirin is right for you.
• Blood pressure medications: High blood pressure can increase the risk of further heart problems. These medications can help control blood pressure, potentially for life.
• Pain relievers: Medicines like nitrates and calcium channel blockers can help relieve chest pain.

2. Procedures to Open the Artery:

If medications aren't enough to restore blood flow or manage pain, procedures to open the artery may be necessary. These include:

• Angioplasty and Stenting: A thin tube (catheter) is inserted into a blood vessel (often in the groin or wrist) and guided to the blocked artery. A small balloon on the catheter tip widens the artery, and a tiny mesh tube (stent) is placed inside to keep it open. This improves blood flow. This procedure is also called percutaneous coronary intervention (PCI).
• Coronary Artery Bypass Graft (CABG) Surgery: This is a more extensive open-heart surgery. A healthy blood vessel (graft) from the chest or leg is connected to the artery below the blockage, creating a new pathway for blood to flow around the blockage. This surgery might be needed if multiple arteries are affected or if other treatments aren't successful.

Important Considerations:

• Pregnancy: If you've had SCAD, it's crucial to talk to your doctor before getting pregnant. Pregnancy may not be safe after SCAD.
• Cardiac Rehabilitation: After treatment, a personalized program of exercise and education is often recommended. This is called cardiac rehabilitation and helps patients recover from serious heart conditions. This program typically includes supervised exercise, emotional support, and education on a heart-healthy lifestyle.
• Follow-up Care: Regular checkups with your healthcare team are essential to monitor your health and manage any potential complications.

This information is for educational purposes only and should not be considered medical advice. Always consult with a healthcare professional for any health concerns or before making any decisions related to your health or treatment.

Experiencing fear, sadness, frustration, or depression after a Spontaneous Coronary Artery Dissection (SCAD) is common. Understanding your health and connecting with others can help. Here are some ways to cope:

Learn about SCAD: Getting detailed information about SCAD can ease your mind and make conversations with your medical team easier. Find out about the specific location and size of the tear in your artery.

Ask Questions: Don't be afraid to ask questions about your treatment and why it's necessary. Inquire about where you can find more information about SCAD. Understanding the reasons behind your treatment plan can help you feel more in control.

Connect with Others: Joining a support group can be very helpful. Sharing your experience with others who understand what you're going through can ease feelings of isolation.

Seek Support Groups: Talk to your healthcare team about SCAD or heart disease support groups in your area. These groups provide a safe space to connect with others facing similar challenges and offer valuable emotional support.