Spontaneous coronary artery dissection (SCAD) occurs when a tear forms in the artery wall of the heart without warning. While SCAD is an increasingly recognized cause of a heart attack, approximately 87-95% of all cases occur in women. Here, Ahmad Jabri, M.D., an interventional cardiology fellow at Henry Ford Health, explains why women are at greater risk and what the outlook is for those who have had SCAD before.
To better understand SCAD, it is helpful to break down what the term “spontaneous coronary artery dissection” really means:
- Spontaneous means the condition happens without warning.
- Coronary arteries are cardiac blood vessels that carry oxygen-rich blood to your heart.
- Dissection is a medical term used to describe the separation of tissue.
“Your heart’s coronary artery wall has three layers,” explains Dr. Jabri. “SCAD describes when a tear (or separation of tissue) in that wall occurs, allowing blood to pass through the innermost layer of the artery wall. When this happens, that blood becomes trapped and bulges inward. This narrows or blocks the blood vessel - preventing blood from reaching the heart muscles and resulting in a heart attack.”
Understanding Your Risk Of SCAD
While cases of SCAD have been known to affect men and women of all ages, most commonly, it affects women ages 40-50. Unlike heart attacks caused by plaque build-up in the heart arteries, SCAD patients are often healthy and without risk factors of heart disease (such as high cholesterol, diabetes, etc.).
“SCAD is likely influenced by a combination of factors that include sex, underlying health conditions, and genetics as well as environmental, physical, or emotional stressors,” says Dr. Jabri. “We’ve also found that SCAD is likely related to the fluctuation in female hormones as it is more likely to occur around the time of menstruation or after menopause.”
Factors that could increase your risk include:
- Very high blood pressure
- Prolonged exposure to extreme physical or emotional stress
- High-dose hormonal therapy
- Drug use
- Pregnancy
- Fibromuscular dysplasia (a condition that causes weakening of medium-sized arteries in the body)
- Genetic conditions that impact your connective tissue such as Ehlers-Danlos or Marfan syndromes
Diagnosing And Treating SCAD
The lack of blood flow to the heart that occurs with SCAD can cause heart attack symptoms including:
- Chest pain
- Shortness of breath
- Excessive sweating
- Feeling dizzy
- Pain in the arms, shoulders, back or jaw
If you are experiencing any of these symptoms, call 911.
Once at the hospital, medical experts can assess your symptoms to determine if what you are experiencing is SCAD. Like other heart attack cases, you may require a procedure to insert a stent to hold the artery open and allow blood flow to return to normal or, bypass surgery to reroute blood to the heart. Often times, other therapies are used to help control your blood pressure levels including long-term aspirin use to prevent blood clots and beta blockers.
Life After SCAD
After being discharged from the hospital, you will have regular appointments with your cardiologist to monitor your condition. Your cardiologist will likely refer you for cardiac rehabilitation so you can learn safe workout techniques while improving your heart health.
“Patients who have had SCAD will need to avoid extreme endurance training, exercising to exhaustion, elite competitive sports and vigorous exertion in extreme temperatures to prevent another SCAD episode,” says Dr. Jabri.
For female SCAD patients, Dr. Jabri notes that while there is no known connection between hormonal birth control use and SCAD, many health care providers recommend that you use nonhormonal birth control options after SCAD.
If you are pregnant or considering pregnancy in your future, make sure you talk with your doctor about your risk for pregnancy-associated SCAD. If you have had SCAD in the past and choose to become pregnant, your pregnancy will be treated as a high-risk pregnancy case to make sure your health and the health of your baby is being closely monitored.
“It is very common for people who have had SCAD to wonder whether it will happen again,” says Dr. Jabri. “There is about a 10% chance that SCAD will reoccur in patients that have had it before. It might happen soon after the first episode or years later. The good news is that most people who have experienced SCAD will go on to live healthy lives without further problems.”
If you have had SCAD or are looking to avoid SCAD in the future, making lifestyle modifications can lower your risk. This includes:
- Exercising regularly
- Maintaining a healthy weight
- Making heart healthy food choices
- Regulating your blood sugar and cholesterol levels
- Quitting smoking and tobacco use
- Limiting alcohol
- Avoiding stress by employing stress management techniques
- Practicing good sleep habits
- Scheduling regular visits with your primary care provider to check in with your overall health
Reviewed by Dr. Ahmad Jabri, an interventional cardiology fellow at Henry Ford Health.
