What to know about spontaneous coronary artery dissection (SCAD)

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SCAD occurs when the innermost layer of the coronary artery (the artery that supplies blood to the heart) suddenly tears without warning, allowing blood to pass into the inner chamber.

The trapped blood then bulges inward, causing a blockage. It may also extend the tear, which can lead to a heart attack due to loss of blood.

In the past, experts believed that this condition was rare, but newer evidence suggests it may be more common than previously thought. In either case, SCAD can be life threatening and requires immediate medical treatment.

Signs and symptoms of SCAD resemble those that people associate with heart attacks. However, unlike a heart attack, about 80% of people seen who have SCAD are “fairly young, healthy, and active.”

Biological females have a higher chance of experiencing SCAD, as about 10–15% of cases occur in males.

SCAD occurs spontaneously and suddenly. Though researchers have not yet defined the exact cause of SCAD, it occurs when a tear appears in the inner layer of the coronary artery.

The tear allows blood to flow into a cavity, which creates an abnormal bulge. The bulge in the artery can block blood flow to the heart. Without treatment, this can lead to a heart attack.

The presentation of SCAD symptoms is similar to those of a heart attack. They can include:

• chest pain or pressure
• shoulder pain
• shortness of breath or trouble breathing
• increased sweating
• dizziness
• temporary loss of consciousness
• nausea

When tested, a person will also likely present with increased levels of cardiac enzymes, which indicate damage to the heart muscle (though these are not specific to SCAD).

As with any type of heart attack, recognizing signs quickly and seeking medical attention helps increase survival. An individual experiencing signs of a SCAD heart attack should seek immediate medical attention or call 911.

Diagnosis presents a challenge to doctors because people often lack common risk factors of cardiac disease. If a doctor suspects a person may have SCAD, they may perform several diagnostic tests to check for the condition.

Testing for SCAD often includes:

• Coronary angiography: This is often the first tool used for diagnosis. It uses X-rays to look at the blood vessels in a person’s heart.
• Intracoronary imaging: This is often used when coronary angiography does not conclusively show SCAD.

There are no other biomarkers in the blood to indicate SCAD, but a person typically has elevated troponin levels.

Some other possible diagnostic tools a doctor may use include:

• checking a person’s vital signs such as blood pressure and heart rate
• an EKG
• cardiac catheterization
• an echocardiogram

SCAD resembles a heart attack, but it requires a different treatment plan. Due to limited knowledge about the condition, there is no standard treatment plan for a doctor to follow.

Instead, a doctor will need to assess the location of the tear as well as the person’s symptoms.

Doctors often prefer conservative therapies, such as medications, to more invasive methods, such as stent placement. However, they may recommend the following:

• Revascularization: Due to risks of complications, a doctor will likely only recommend this procedure if necessary.
• Device implantation: A doctor may recommend the implantation of a cardioverter defibrillator or a mechanical left ventricular assist device for more serious cases.
• Medications: Studies do not definitively support the use of any specific medications. However, a doctor may recommend statin therapy, beta-blockers, or long-term aspirin.

People may also require a heart transplantation.

Often, a person will not know they have SCAD until they experience a heart attack. They also may not suspect any issues because people who often develop SCAD do not typically have the risk factors associated with heart disease or heart attack.

According to a 2018 study, risk factors for SCAD may include being biologically female and being pregnant.

Some other risk factors may include:

• high blood pressure
• extreme physical exertion
• smoking
• drug misuse
• extreme emotional distress
• living with an autoimmune disease
• living with fibromuscular dysplasia
• experiencing issues with blood vessels

Without treatment, SCAD can lead to major complications. These can include:

• blocked blood flow to the heart
• heart failure
• arrhythmia
• cardiac-related death

With prompt medical attention, a person will likely survive SCAD. However, they will often need continued monitoring due to the risk of relapse.

About 1–5% of people who develop SCAD will not survive it, with another 14% needing hospitalization to treat the condition.

Females, particularly those who are postpartum, tend to have a worse outlook than others.

SCAD is a spontaneous, sudden break in the inner wall of the coronary artery.

When it occurs, it can cause a person to have a heart attack and can lead to death.

A person who has SCAD does not typically have the warning signs and risk factors associated with heart disease. They also tend to be younger than those who are typically most at risk of a heart attack. Females are more likely to develop SCAD than males.

With treatment, most people recover from SCAD, though they have a higher chance of developing it again than someone who has never had SCAD.