Diagnosis

Tests used to diagnose SCAD are similar to those used to evaluate other types of heart attacks.

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 into 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 SCAD. A coronary angiogram can also show if the arteries in the heart (coronary arteries) are abnormal and twisted (tortuous arteries).

Intravascular ultrasound

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

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 can help doctors confirm the diagnosis and gather information to guide treatment.

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 SCAD.

Treatment

The goal of treatment for SCAD is to restore blood flow to your heart. Sometimes, this healing will occur naturally. In others, doctors may have to restore blood flow by opening the artery with a balloon or stent. Bypass surgery may also be used.

The treatments most appropriate for you will depend on your condition, including the size and location of the tear in the 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 using invasive procedures.

For some people, medications may relieve the symptoms of 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 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 guide the tube to the arteries in your heart. X-rays are used to help the doctor see where to place the catheter.

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 SCAD, your doctor may recommend medications, including:

  • Aspirin. Aspirin may help prevent cardiovascular disease problems after 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 the 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 SCAD.
  • Medications to control chest pain. These medications (nitrates and calcium channel blockers) can help treat chest pain you may experience after 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 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. 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 have had 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 FMD.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Coping and support

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 finds 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:

  • Learn more about your diagnosis. Learn enough about SCAD to feel comfortable talking with your doctor about your care. Ask about 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 SCAD, your doctor may recommend you avoid pregnancy. Talk to your doctor about his or her recommendations.

    Ask your health care team about where you can find more information about SCAD.

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

    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.

  • Connect with others living with your diagnosis. SCAD is uncommon, but national organizations can 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.
  • Spend time with family and friends. Spending time with your family and friends and discussing your concerns can help you cope with your condition.

Preparing for your appointment

In most cases, 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 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 SCAD?
  • Do I have abnormalities of other blood vessels, such as 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.

Spontaneous coronary artery dissection (SCAD) care at Mayo Clinic

Oct. 31, 2019
  1. Douglas PS, et al. Spontaneous coronary artery dissection. https://www.uptodate.com/contents/search. Accessed June 21, 2019.
  2. Janssen EBNJ, et al. Spontaneous coronary artery dissections and associated predisposing factors: A narrative review. Netherlands Heart Journal. 2019;27:246.
  3. Saw J, et al. Contemporary review on spontaneous coronary artery dissection. Journal of the American College of Cardiology. 2016;68:297.
  4. Warning signs of a heart attack. American Heart Association. https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack. Accessed June 25, 2019.
  5. Waterbury TM, et al. Natural history of spontaneous coronary artery dissection. Circulation: Cardiovascular Interventions. 2018;11:1.
  6. Tan NY, et al. Spontaneous coronary artery dissection: Etiology and recurrence. Expert Review of Cardiovascular Therapy. 2019; doi: 10.1080/14779072.2019.
  7. Ciurica S, et al. Arterial tortuosity. Hypertension. 2019;73:951.
  8. Krittanawong C, et al. Conditions and factors associated with spontaneous coronary artery dissection (from a national population-based cohort study). American Journal of Cardiology. 2019;123:249.
  9. AskMayoExpert. Spontaneous coronary artery dissection (SCAD). Mayo Foundation for Medical Education and Research; 2018.
  10. Tweet MS, et al. Multimodality imaging for spontaneous coronary artery dissection in women. JACC: Cardiovascular Imaging. 2016;9:436.
  11. McAlister C, et al. Angiographic characteristics of spontaneous coronary artery dissection. Heart, Lung and Circulation. 2018;27:S11.
  12. American Heart Association. Spontaneous coronary artery dissection: Current state of the science. Circulation. 2018;137:e523.
  13. What is a stent? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/stents. Accessed June 25, 2019.
  14. What is coronary artery bypass grafting? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/coronary-artery-bypass-grafting. Accessed June 25, 2019.
  15. Krittanawong C, et al. Usefulness of cardiac rehabilitation after spontaneous coronary artery dissection. American Journal of Cardiology. 2016;117:1604.
  16. Kaadan MI, et al. Prospective cardiovascular genetics evaluation in spontaneous coronary artery dissection. Circulation: Genomic and Precision Medicine. 2018;11:e001933.
  17. American Heart Association. Coping with feelings. https://www.heart.org/en/health-topics/cardiac-rehab/taking-care-of-yourself/coping-with-feelings. Accessed July 5, 2019.
  18. Mankad R (expert opinion). Mayo Clinic, Rochester, Minn. August 2019.
  19. Riggin EA. Allscripts EPSi. Mayo Clinic. June 21, 2019.
  20. Waterbury TM, et al. Early natural history of spontaneous coronary artery dissection. Circulation: Cardiovascular Interventions. 2018;11:e0006772.