When you think of the profile of a typical person with heart problems, do you visualize an older person with multiple risk factors like obesity and diabetes, and someone who smokes and leads a sedentary lifestyle? When it comes to Spontaneous Coronary Artery Dissection (SCAD), you may need to think again. SCAD is different than a classic heart attack and the risk factors differ too. SCAD most often affects younger women and individuals with few typical risk factors for heart disease.
How Does SCAD Happen?
SCAD occurs when there is a tear in a coronary artery - the vessels supplying blood to your heart. “While uncommon, SCAD is an emergent and possibly fatal condition,” said Divya Ratan Verma, MD, an interventional cardiologist with Banner Health in Arizona. The tear can cause blood to collect between the layers of tissue in the coronary artery wall, instead of flowing directly to the heart. “Because the tear is slowing, or even stopping the blood flow to your heart, if not diagnosed promptly, SCAD can lead to a heart attack and even be fatal.”
Symptoms of Spontaneous Coronary Artery Dissection
SCAD can be difficult to diagnose and as such, is commonly underdiagnosed. There is a wide spectrum of symptoms, including:
- Chest pain
- Shortness of breath
- Heart palpitations
- Sudden cardiac death
Most SCAD symptoms mimic those of a heart attack. “Patients with SCAD are often given an incorrect diagnosis and are at risk of being discharged from the emergency department without further evaluation,” said Dr. Verma. “But with improved awareness and imaging techniques we are now able to diagnose this condition more appropriately and our understanding has evolved tremendously in the past five years.”
Are You at Risk?
Both men and women can develop SCAD, but it’s more often seen in younger women, according to Dr. Verma. “SCAD is the most common cause of pregnancy-related heart attack, with the highest risk being in the third trimester to six weeks postpartum,” said Dr. Verma. “This is because increased blood flow and the hormonal effects of pregnancy can weaken the walls of the coronary arteries.” After a first pregnancy, the risk continues to go up with each subsequent pregnancy because the damage to the coronary arteries increases, according to Dr. Verma.
Other stressors to your body that could cause SCAD include exercise, emotional stress, fibromuscular dysplasia (a condition that causes vessels to narrow), connective tissue disorders like Ehlers-Danlos syndrome, substance abuse or uncontrolled hypertension.
How SCAD is Treated
If your doctor suspects you have a spontaneous coronary artery dissection, he or she will likely do a blood test evaluating a cardiac biomarker called troponin, an electrocardiogram, and possibly a coronary angiography to see how the blood is flowing through the arteries in your heart. “If a tear is detected, in most cases it can be managed with medications like antiplatelet, or blood thinners, statins and beta blockers,” said Dr. Verma. In some cases, a procedure called percutaneous coronary intervention may be done to place a stent in the vessel to open it up for better blood flow.
If you are showing risk factors and are concerned you may have a spontaneous coronary artery dissection, schedule an appointment with a Banner Health cardiologist.