Spontaneous coronary artery dissection (SCAD)

Overview

Spontaneous coronary artery dissection is an emergency condition that occurs when a tear forms in a wall of a heart artery. Spontaneous coronary artery dissection also is called SCAD.

SCAD can slow or block blood flow to the heart, causing a heart attack, heart rhythm problems or sudden death.

SCAD most commonly affects women in their 40s and 50s, though it can occur at any age and can occur in men. People who have SCAD often don't have risk factors for heart disease, such as high blood pressure, high cholesterol or diabetes.

SCAD can cause sudden death if it isn't treated promptly. Get emergency medical help if you have heart attack symptoms — even if you think you aren't at risk of a heart attack.

Symptoms

Symptoms of SCAD can include:

• Chest pain or pressure.
• Pain in the arms, shoulders, back or jaw.
• Shortness of breath.
• Unusual sweating.
• Extreme tiredness.
• Upset stomach.
• A rapid heartbeat or fluttery feeling in the chest.
• Feeling dizzy.

When to see a doctor

Call 911 or your local emergency number if you have chest pain or think you might be having a heart attack. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Do not drive yourself unless you have no other choice.

Causes

The cause of spontaneous coronary artery dissection is unknown.

Risk factors

Risk factors for SCAD include:

• Being female. SCAD can happen to anyone. But it tends to affect women more than men.
• Childbirth. Some women who have had SCAD have recently given birth. This may be due to changes in hormones and stress on the blood vessels. SCAD has been found to occur most often in the first few weeks after delivery. But SCAD also can occur during pregnancy.
• Extreme stress. SCAD can happen after extreme stress. This includes intense physical exercise and severe emotional distress.
• Fibromuscular dysplasia (FMD). This condition causes weakening of the body's medium-sized arteries. FMD may lead to artery problems such as aneurysm or dissection. Women are more likely to have it than men.
• Genetic conditions affecting connective tissue. Ehlers-Danlos and Marfan syndromes have been found to occur in people who have had SCAD.
• Very high blood pressure. Severe high blood pressure can raise the risk of SCAD.
• Illegal drug use. Using cocaine or other illegal drugs might increase the risk of SCAD.

Complications

A possible complication of SCAD is heart attack. SCAD slows or stops blood flow through an artery. This weakens the heart and may lead to a heart attack. A heart attack from SCAD is different from a heart attack caused by a buildup of fats, cholesterol and other substances in and on the artery walls. This condition is called atherosclerosis.

In some people with SCAD, the inner and outer layers of the artery may split. Blood can collect between these layers. Pressure from the pooled blood can make SCAD worse.

Even with successful treatment, SCAD can happen more than once. It might happen soon after the first episode or years later. People who have SCAD also may have a higher risk of other heart problems. These problems include heart failure due to the heart attack damage.

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