SCAD: The Under-the-Radar Heart Problem

Quick – what is SCAD?

If you didn’t guess “spontaneous coronary artery dissection” because you’ve never heard of that, don’t fret. SCAD is increasingly recognized as a cause of heart attacks. Our knowledge base regarding this condition is expanding.

This lack of information about SCAD can leave people who experience the condition feeling shocked, confused and scared. Knowing the basics can give you the information you need to speak with your doctor or clinician about it. In addition, it’s important to know that SCAD can occur in young women.

SCAD is a spontaneous tear in the coronary artery wall.

The walls of the vessels that carry blood to your heart have three layers. SCAD occurs when one of those layers gets a tear in it or separates. “The tear allows blood to enter the artery wall, where it becomes trapped and expands,” says cardiologist Ellina Feiner, MD, with LVH Cardiology–1250 Cedar Crest. “It can close off the true lumen of the artery. This in turn closes off flow.”

People with SCAD do not carry traditional risk factors for a classic heart attack related to atherosclerosis. They usually don’t have a history of diabetes, hypertension, hyperlipidemia or smoking.

But scientists have been able to point to a few common risk factors for SCAD. The majority of people affected by SCAD are women in their 40s and 50s. Although SCAD in pregnant people is rare, the condition is the most common cause of heart attacks during pregnancy.

Risk factors for SCAD include:

• Fibromuscular dysplasia
• Hormone use
• Other conditions affecting blood vessels, inflammatory or autoimmune conditions
• Inherited connective tissue diseases
• Very high blood pressure
• Extreme exertion
• Illegal drug use
• Emotional upset

Many heart attacks occur because of plaque buildup in coronary arteries – a common form of heart disease. “But SCAD isn’t related to plaque at all, and people with SCAD don’t usually have heart disease risk factors,” Dr. Feiner says.

Dr. Feiner notes that “symptoms of a SCAD heart attack are the same as symptoms of a regular heart attack. Chest pain, shortness of breath, dizziness and sweating, arm and jaw pain are key in suspecting a heart attack in young women.”

Doctors and clinicians may use tools that view the inside of arteries to diagnose SCAD. They can also use a coronary angiogram, but SCAD may be more difficult to see with that method.

Treatment focuses on opening up an artery when appropriate, supporting a person clinically throughout a heart attack and close monitoring. Long-term treatment focuses on controlling blood pressure.