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Spontaneous coronary artery dissection (SCAD)

Overview

Spontaneous coronary artery dissection — sometimes referred to as SCAD — is an uncommon emergency condition that occurs when a tear forms in one of the blood vessels in the heart.

Spontaneous coronary artery dissection (SCAD) can slow or block blood flow to the heart, causing a heart attack, abnormalities in heart rhythm or sudden death.

Spontaneous coronary artery dissection (SCAD) most commonly affects women in their 40s and 50s, though it can occur at any age or in men. People who develop spontaneous coronary artery dissection (SCAD) are often healthy. Most don't have risk factors for heart disease, such as high blood pressure and diabetes.

Spontaneous coronary artery dissection (SCAD) can lead to sudden death if it isn't diagnosed and treated promptly. For this reason, seek emergency attention if you experience heart attack signs and symptoms — even if you think you aren't at risk for a heart attack.

Symptoms

Signs and symptoms of spontaneous coronary artery dissection (SCAD) are the same as symptoms of other types of heart attacks and may include:

  • Chest pain
  • A rapid heartbeat or fluttery feeling in your chest
  • Pain in your arms, shoulders or jaw
  • Shortness of breath
  • Sweating
  • Unusual, extreme tiredness
  • Nausea
  • Dizziness

When to see a doctor

If you experience chest pain or suspect you're having a heart attack, immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last resort.

Causes

It's not clear what causes spontaneous coronary artery dissection (SCAD).

Spontaneous coronary artery dissection (SCAD) causes a tear inside an artery. When the inner layers of the artery separate from the outer layers, blood can pool in the area between the layers. The pressure of the pooling blood can make a short tear much longer. And blood trapped between the layers can form a blood clot (hematoma).

Spontaneous coronary artery dissection (SCAD) may slow blood flow through the artery to the heart, which makes the heart muscle weaken. Or blood flow through the artery can be completely stopped, causing heart muscle to die (heart attack). A heart attack that occurs in SCAD is different from a heart attack caused by hardening of the arteries (atherosclerosis).

Blood flow in arteries in spontaneous coronary artery dissection (SCAD)

In spontaneous coronary artery dissection (SCAD), a tear forms in an artery in the heart. This can cause blood to pool in the area between the layers. Blood trapped between the layers can form a blood clot (hematoma). SCAD can reduce or block blood flow through the artery, which can cause a heart attack. However, a heart attack in SCAD is different from a heart attack caused by hardening of the arteries (atherosclerosis), shown in the bottom image.

Risk factors

Doctors and researchers have found some similarities among people who have experienced spontaneous coronary artery dissection (SCAD). It's not yet clear what role these factors play in causing the disease. Common factors include:

  • Female sex. Though spontaneous coronary artery dissection (SCAD) can occur in both men and women, it tends to affect women more often.
  • Giving birth. Some women with spontaneous coronary artery dissection (SCAD) have recently given birth. Spontaneous coronary artery dissection (SCAD) was found to occur most often in the first few weeks after delivery.
  • Underlying blood vessel conditions. Some underlying blood vessel abnormalities have been associated with SCAD, most commonly a condition called fibromuscular dysplasia (FMD), which causes the irregular growth of cells in the walls of one or more of your arteries. This irregular growth can weaken the artery walls, leading to blockages, dissections or aneurysms.

    Fibromuscular dysplasia can also cause high blood pressure, a stroke and tears in other blood vessels. Fibromuscular dysplasia occurs more often in women than it does in men.

  • Extreme physical exercise. People who recently participated in extreme or intense exercises, such as extreme aerobic activities, may be at higher risk of SCAD.
  • Severe emotional stress. Someone who has experienced severe emotional stress, such as a sudden death in the family, may be at higher risk of SCAD.
  • Blood vessel problems. Diseases that cause inflammation of the blood vessels, such as lupus and polyarteritis nodosa, have been associated with spontaneous coronary artery dissection (SCAD).
  • Inherited connective tissue diseases. Genetic diseases that cause problems with the body's connective tissues, such as vascular Ehlers-Danlos syndrome and Marfan syndrome, have been found to occur in people with spontaneous coronary artery dissection (SCAD).
  • Very high blood pressure. Having untreated, severe high blood pressure can be associated with spontaneous coronary artery dissection (SCAD).
  • Illegal drug use. Using cocaine or other illegal drugs may increase the risk of spontaneous coronary artery dissection (SCAD).

Complications

In some people, spontaneous coronary artery dissection (SCAD) can occur again, despite successful treatment. It may recur soon after the initial spontaneous coronary artery dissection (SCAD) or years later. People who have spontaneous coronary artery dissection (SCAD) may also have a higher risk of other heart problems, such as heart failure.

Doctors are studying why spontaneous coronary artery dissection (SCAD) recurs and who is most likely to experience a recurrence.

Diagnosis

To diagnose spontaneous coronary artery dissection (SCAD), your doctor may review your signs and symptoms, and order several tests. The tests are similar to those used to evaluate other heart attacks, such as electrocardiograms and blood tests to detect blood damage. If a heart attack is suspected or diagnosed, it is typically confirmed by taking images of your arteries to look for signs of abnormalities.

Tests may include:

Coronary angiogram

During a coronary angiogram, doctors inject a special dye into your arteries so they'll show up on imaging tests. To get the dye to your arteries, doctors insert a long, thin tube (catheter) into an artery — usually in your leg or arm — and thread the tube to the arteries in your heart.

Once the dye is released, doctors use X-rays to create pictures of the arteries. The X-rays may show abnormalities in an artery that help confirm spontaneous coronary artery dissection (SCAD). A coronary angiogram can also show if the arteries in the heart (coronary arteries) are abnormal and twisted, called tortuous coronary arteries, which can occur in some people with SCAD.

Intravascular ultrasound

During heart catheterization, a special imaging catheter may be passed into your arteries to create sound-wave pictures (ultrasound). This may be conducted in addition to coronary angiography to help doctors confirm spontaneous coronary artery dissection (SCAD) and plan treatment decisions.

Optical coherence tomography

A catheter equipped with a special light may be passed into your arteries to create light-based pictures. Doctors may perform this test after coronary angiography.

The images may show abnormalities in an artery that help doctors confirm spontaneous coronary artery dissection (SCAD) and gather information to guide treatment decisions.

Cardiac computerized tomography (CT) angiography

During cardiac computerized tomography (CT) angiography, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show abnormalities in your arteries.

Cardiac CT angiography may be used in addition to other tests or as a follow-up test to evaluate your condition after spontaneous coronary artery dissection (SCAD).

Cardiac catheterization procedure approaches

In a cardiac catheterization procedure, doctors insert a catheter in an artery in your groin (femoral artery) or in your wrist (radial artery). The catheter is then threaded through your blood vessels to your heart.

Cardiac catheterization procedure approaches

In a cardiac catheterization procedure, doctors insert a catheter in an artery in your groin (femoral artery) or in your wrist (radial artery). The catheter is then threaded through your blood vessels to your heart.

Coronary angiogram

To complete a coronary angiogram, a catheter is inserted in an artery in your groin or arm and threaded through your blood vessels to your heart. Your doctor uses the angiogram to check for blocked or narrowed blood vessels in your heart.

Heart with tortuous coronary arteries

In spontaneous coronary artery dissection (SCAD), the arteries in the heart (coronary arteries) may sometimes be twisted (tortuous arteries).

Treatment

The goal of treatment for spontaneous coronary artery dissection (SCAD) is to restore blood flow to your heart. In some cases this healing will occur naturally. In others, doctors may have to restore blood flow by opening the artery with a balloon or stent, or surgically bypassing the artery.

The treatments most appropriate for you will depend on your condition, including the size and location of the tear in your artery, as well as any signs or symptoms you're experiencing. Whenever possible, doctors allow the damaged artery to heal on its own, rather than repairing it through invasive procedures.

For some people, medications may relieve symptoms of spontaneous coronary artery dissection (SCAD). In these situations, it may be possible to be treated by medications alone. If chest pain or other symptoms persist, other treatments may be needed.

Placing a stent to hold the artery open

If your spontaneous coronary artery dissection (SCAD) has blocked blood flow to your heart or if medications don't control your chest pain, your doctor may recommend placing a tiny mesh tube (stent) inside your artery to hold it open. A stent can help restore blood flow to your heart.

To position the stent, doctors insert a long, thin tube (catheter) into an artery — usually in your leg or arm — and thread the tube to the arteries in your heart. The catheter is guided to your damaged artery using X-rays.

A wire with a deflated balloon is passed through the catheter to the tear in the artery. The balloon is then inflated, expanding the stent against your artery walls. The stent is left in place to hold the artery open.

Surgery to bypass the damaged artery

If other treatments haven't worked or if you have more than one tear in an artery, your doctor may recommend surgery to create a new way for blood to reach your heart.

Coronary bypass surgery involves removing a blood vessel from another part of your body, such as your leg. That blood vessel is stitched into place so that it diverts blood flow around your damaged artery.

Medications

After spontaneous coronary artery dissection (SCAD), your doctor may recommend medications, including:

  • Aspirin. Aspirin may help prevent cardiovascular disease problems after spontaneous coronary artery dissection (SCAD).
  • Blood-thinning drugs. Drugs that reduce the number of blood-clotting platelets in your blood (anticoagulants) can reduce the risk of a clot forming in your torn artery.
  • Blood pressure drugs. Drugs used to treat high blood pressure can lower your heart's demand for blood, reducing the pressure in your damaged artery. You may continue to take blood pressure drugs indefinitely to reduce the risk of another spontaneous coronary artery dissection (SCAD).
  • Medications to control chest pain. These medications (nitrates and calcium channel blockers) can help treat chest pain you may experience after spontaneous coronary artery dissection (SCAD).
  • Cholesterol drugs. People who have abnormal cholesterol levels and other risk factors may need to take medications to control their cholesterol levels.

Continuing care

After your treatment for spontaneous coronary artery dissection (SCAD), you'll need regular follow-up appointments with your doctor to monitor for any changes in your condition. Your doctor may also recommend other types of care to help you recover and to prevent other health problems. These may include:

  • Undergoing cardiac rehabilitation. Cardiac rehabilitation is a customized program of exercise and education designed to help you recover from a serious heart condition, such as a heart attack caused by spontaneous coronary artery dissection (SCAD). Cardiac rehabilitation often includes monitored exercise, nutritional counseling, emotional support and education.
  • Reviewing your family medical history. Some inherited conditions, such as the connective tissue disease Marfan syndrome, have been found to occur in people who experience spontaneous coronary artery dissection (SCAD). Your doctor may refer you to a genetic counselor to review your family medical history and determine whether genetic testing may be appropriate for you.
  • Looking for weaknesses in other blood vessels. Your doctor may recommend using CT angiography to look for weaknesses and abnormalities in other blood vessels, such as fibromuscular dysplasia (FMD).

Preparing for an appointment

In most cases, spontaneous coronary artery dissection (SCAD) is an emergency situation. If you experience chest pain or suspect you're having a heart attack, immediately call 911 or your local emergency number.

In the days after your initial diagnosis, you're likely to have many questions about your situation. Because meetings with doctors can be brief, and because there's often a lot to discuss, it's a good idea to prepare by writing down your questions. Order them from most important to least important, in case time runs out.

Some questions you may want to ask include:

  • What caused my spontaneous coronary artery dissection (SCAD)?
  • What are other possible causes for my symptoms or condition?
  • What kinds of tests do I need?
  • What's the most appropriate treatment?
  • Will the tear in my artery heal on its own?
  • What are the alternatives to the primary approach that you're suggesting?
  • What is my risk of having another spontaneous coronary artery dissection (SCAD)?
  • Do I have abnormalities of other blood vessels, such as fibromuscular dysplasia (FMD)?
  • I have these other health conditions. How can I best manage them together?
  • Are there any restrictions that I need to follow?
  • If I would like more children, is it safe for me to be pregnant?
  • Should I see a specialist? What will that cost, and will my insurance cover it?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions that occur to you.

Coping and support

Spontaneous coronary artery dissection (SCAD) can be an unexpected and shocking diagnosis. The condition can cause serious and scary symptoms, and it often affects people who may have few risk factors for heart disease.

Each person may find his or her own way of coping with a diagnosis. In time you'll find what works for you. Until then, you might try to:

  • Find out more about your diagnosis. Find out enough about spontaneous coronary artery dissection (SCAD) so that you can feel comfortable participating in decisions about your care. Ask your doctor for the specifics of your situation, such as the location and size of your artery tear and descriptions of the treatments you've received.

    If you're a woman and you have had spontaneous coronary artery dissection (SCAD), your doctor may recommend you avoid pregnancy. Talk to your doctor about his or her recommendations.

    Talk with your health care team about where you can find more information about spontaneous coronary artery dissection (SCAD).

  • Connect with others living with your diagnosis. Spontaneous coronary artery dissection (SCAD) is uncommon, but national organizations can help connect you to others who share your diagnosis. Organizations such as the American Heart Association and WomenHeart: The National Coalition for Women with Heart Disease can provide telephone and online support.
  • Take care of yourself. Help your body recover by taking good care of yourself. For instance, get enough sleep so that you wake feeling rested, choose a healthy diet full of fruits and vegetables, and find healthy ways to cope with stress, such as listening to music or writing down your thoughts.

    If your doctor feels it's safe, try to do moderate physical activity, such as walking, for 30 to 40 minutes most days of the week.

    If you feel depressed or anxious, talk to your doctor. Your doctor may recommend that you talk to a mental health professional (psychologist).

  • Spend time with family and friends. Spending time with your family and friends and discussing your concerns can help you cope with your condition.

Last updated: March 3rd, 2017

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