17503 Spontaneous Coronary Artery Dissection Scad

Overview

Spontaneous coronary artery dissection (SCAD) is a rare heart emergency where a tear forms in the wall of one of the blood vessels that supplies your heart muscle. Blood gets trapped between the layers of the vessel wall, which can slow or block blood flow and cause a heart attack.

SCAD is rare, but it is a major cause of heart attacks in young women. Doctors are recognizing it more often as testing improves.

SCAD can affect anyone, but it is most commonly seen in women in their 40s and 50s. It can also occur during pregnancy or soon after childbirth, in people who are otherwise healthy, and sometimes in men.

Symptoms

Common symptoms

• Chest pain or pressure (often sudden and severe)
• Pain spreading to an arm, shoulder, jaw, neck, or back
• Shortness of breath
• Sweating
• Nausea or feeling sick
• Dizziness or light-headedness

Symptoms in children

• Chest pain or discomfort
• Unusual tiredness or fatigue
• Shortness of breath

Symptoms in older adults

• The same symptoms as in younger adults, such as chest pain and breathlessness
• New or worsening chest pain that may be mistaken for indigestion
• Feeling generally unwell or faint

Causes

Main causes

• A sudden tear in the coronary artery wall (the exact reason is often unknown)
• Hormone changes, especially during pregnancy or after birth
• Extreme emotional stress or intense physical exertion, which may increase blood pressure and stress on the artery wall

Risk factors

• Being female, especially under 50
• Having recently given birth or being pregnant
• Having a history of migraine, fibromuscular dysplasia, or blood vessel conditions
• High blood pressure
• Very intense exercise (such as heavy lifting or extreme endurance sports)

When to see a doctor

See a doctor urgently if:

• Any new or unexplained chest pain, breathlessness, or fainting — call your local emergency number
• If you have had SCAD before and have new symptoms, seek care urgently

Book a routine appointment if:

• If you have had a heart attack treated with stents or surgery and want to understand your heart health
• If you have been told you have fibromuscular dysplasia and want to check your heart arteries

Diagnosis

Doctors diagnose SCAD by looking at your heart arteries with imaging tests. It may take several tests because the tear can be hard to see.

Tests that may be done

• Electrocardiogram (ECG) — checks the heart’s electrical activity
• Blood tests — look for markers of heart damage
• Coronary angiogram — a dye is injected into the arteries to see blockages
• Intracoronary imaging (such as optical coherence tomography) — gives a closer look at the artery wall

What to expect at your appointment

If SCAD is suspected, you will be admitted to hospital, often to a coronary care or intensive care unit. The medical team will watch you closely. Recovery takes time, and you may need to stay in hospital for several days.

Treatment

Treatment for SCAD depends on how severe the tear is and how much blood flow is affected. Many people get better without surgery or stents. The body can often heal the torn artery on its own over several weeks.

Self-care at home

• Rest and avoid strenuous activity until your doctor says it is safe
• Take all prescribed medicines exactly as directed
• Avoid chest pain triggers, such as extreme stress or heavy lifting
• Attend cardiac rehabilitation if offered

Medical treatments

Your doctor may recommend medicines to relieve chest pain, control blood pressure, or prevent blood clots. (No specific drug names are provided here.) Sometimes dissolvable stents are used to keep the artery open, but in SCAD this is less common than in usual heart attacks. Your doctor will tailor treatment to your situation.

When is surgery considered?

In rare cases, if the tear blocks blood flow severely or causes repeated problems, bypass surgery may be needed to redirect blood around the damaged area.

Living with this condition

After SCAD, most people need time to recover. Cardiac rehabilitation can help you regain strength and confidence. It's important to follow your doctor’s advice about activities, driving, and returning to work.

Lifestyle tips

• Avoid smoking
• Manage stress with relaxation techniques or mindfulness
• Limit heavy lifting or intense exercise until cleared
• Keep follow-up appointments with your heart specialist

Diet and exercise

Eat a balanced diet with plenty of vegetables, whole grains, and lean protein. Gentle exercise such as walking is usually safe after a few weeks, but ask your doctor before starting any new activity.

Mental health and emotional wellbeing

Feeling anxious or low after a heart event is normal. It can be frightening to live with the memory of a heart attack. Talk to your doctor about counselling or support groups. If you have thoughts of harming yourself, contact your local crisis support line or go to an emergency department.

Prevention

There is no sure way to prevent SCAD because the cause is often unknown. If you have had SCAD, taking care of your heart health and managing stress may reduce the risk of another event. Discuss a prevention plan with your doctor.

Vaccines

Stay up to date with your recommended vaccines, especially those that prevent respiratory infections, because infections can put extra strain on your heart.

Screening programmes

If you have a condition that increases your risk of SCAD, such as fibromuscular dysplasia, your doctor may recommend regular heart imaging. There is no routine screening test for SCAD in the general population.

Complications

If left untreated

• Heart attack and damage to heart muscle
• Serious heart rhythm problems (arrhythmias)
• Cardiogenic shock (when the heart cannot pump enough blood)
• In rare cases, sudden cardiac arrest

Long-term outlook

With prompt treatment, most people survive SCAD. Many return to a full and active life. The artery often heals on its own, and the long-term outlook is generally good, although some people may have another SCAD or long-term heart problems. Your doctor can help you manage your risks and keep your heart as healthy as possible.

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