Definition

What is spontaneous coronary artery dissection (SCAD)?

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.

How common is spontaneous coronary artery dissection (SCAD)?

Spontaneous coronary artery dissection is uncommon. SCAD can occur at any age, but most cases occur in otherwise healthy people between the ages of 30 and 50. SCAD is far more common in women than men. In one study of 440 cases of SCAD that occurred at a single hospital between 1931 and 2008, 98 percent involved women. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of spontaneous coronary artery dissection (SCAD)?

The common symptoms of spontaneous coronary artery dissection (SCAD) are:

  • 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

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you experience chest pain or suspect you’re having a heart attack, immediately call 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

What causes spontaneous coronary artery dissection (SCAD)?

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).

Risk factors

What increases my risk for spontaneous coronary artery dissection (SCAD)?

There are many risk factors for spontaneous coronary artery dissection (SCAD), such as:

  • 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).

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is spontaneous coronary artery dissection (SCAD) diagnosed?

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).

How is spontaneous coronary artery dissection (SCAD) treated?

Treatment for SCAD depends on the symptoms and severity of the disease, ranging from chest pain to heart attack. SCAD is a rare disease, and a heart attack caused by SCAD is not a typical heart attack. For these reasons, it is important that an individual with SCAD be treated by a doctor who is experienced in diagnosing and treating this disease.

Treatment may include any of the following or a combination:

  • Letting the dissection heal.
  • Blood thinners (like warfarin) to reduce the risk of blood clots.
  • Other medications like beta-blockers, particularly in individuals who have FMD.
  • A stent is a tiny mesh tube that is placed in the artery to hold it open.
  • Bypass surgery. Bypass surgery uses a healthy blood vessel from another area of the body to create a bypass around the dissected area of the coronary artery.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage spontaneous coronary artery dissection (SCAD)?

The following lifestyles and home remedies might help you cope with spontaneous coronary artery dissection (SCAD):

  • 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.
  • 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.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: December 11, 2017 | Last Modified: December 11, 2017

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