What is spontaneous coronary artery dissection (SCAD)? Spontaneous coronary artery dissection (SCAD) is a sudden tear in the wall of a coronary artery. Arteries are basically tubes with three-layered walls and an open lumen. The lumen is the inside space where the blood flows. Coronary arteries supply freshly-oxygenated blood to the heart muscle. When the innermost layer of a coronary artery wall tears, the layers separate. This allows blood to flow between the layers. As blood collects in this space, it causes a bulge that presses into the lumen space. The bulge narrows the artery and can partially or completely block blood flow causing a heart attack. SCAD is a rare condition. While it can happen to anyone, it is more common in women in their 40s and 50s. In fact, about 90% of cases are women. It is also the most common cause of heart attack in women under 50. Unlike typical heart attacks, these women do not have atherosclerosis—or hardening of the arteries due to plaque buildup. This difference is important for both diagnosing and treating the condition. SCAD heart attack symptoms are the same as a heart attack due to atherosclerosis. Common symptoms include chest pain, shortness of breath, profuse sweating, and anxiety. But keep in mind that women often experience different symptoms of heart attack. This can include fatigue, weakness, and back or jaw pain. Spontaneous coronary artery dissection treatment depends on the size and location of the tear. Treatment options for SCAD are different from typical heart attack treatments. Many only require medications to relieve symptoms and promote healing. Some will require a procedure to clear the block in the artery or bypass the block. It can be challenging to recognize SCAD. Most women are otherwise healthy and do not have risk factors for heart disease. But it’s vital to seek treatment because it can be fatal. Seek immediate medical care (call 911) for symptoms of a heart attack, such as chest pain and difficulty breathing, which may occur with dizziness, sweating, fainting and anxiety. What are the symptoms of spontaneous coronary artery dissection (SCAD)? A SCAD heart attack has similar symptoms to a heart attack due to atherosclerosis. Although heart attack symptoms can differ, the classic one is crushing chest pain. However, not everyone will have chest pain with a heart attack. Symptoms can be mild or vague, such as dizziness or weakness. In addition, women often experience symptoms other than chest pain. They are more likely to feel tired or have back or jaw pain. Serious symptoms that might indicate a life-threatening condition SCAD is a life-threatening condition. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including: Chest pain, pressure, squeezing, tightness or fullness Fatigue, fainting, or passing out Nausea and vomiting Pain in the jaw, neck, back, shoulders or arms, either alone or radiating from the chest Paleness or a bluish discoloration to the lips, skin or nails Profuse sweating Sudden anxiety, restlessness, or shortness of breath or labored breathing What causes spontaneous coronary artery dissection (SCAD)? SCAD occurs when the innermost layer of a coronary artery tears. This allows the three layers of the artery wall to separate. The separation allows blood to flow in the area between the layers. As it pools in this space, it causes the wall to bulge into the center of the artery. This can narrow the artery and slows blood flow to the heart muscle, which weakens the heart. It can also completely block blood flow through the artery causing heart attack, cardiac arrest, and sudden death. It’s unclear what exactly triggers the tear leading to SCAD. What are the risk factors for spontaneous coronary artery dissection (SCAD)? Research has identified several factors that increase the risk of developing SCAD. Doctors do not fully understand how these factors contribute to SCAD, but they are common among people with the disease. Risk factors for SCAD include: Age: SCAD can occur at any point during life, from teenage years to old age. However, the most commonly affected age group is women between the ages of 30 and 50. The average age is 42 years. Blood vessel conditions: These underlying conditions are present in up to 60% of cases. Fibromuscular dysplasia (FMD), which affects women more than men, is the most common. FMD causes irregular or abnormal cell growth in artery walls. Diseases, such as lupus, that cause blood vessel inflammation also seem to have a link. Connective tissue diseases: About 5% of SCAD patients have an underlying connective tissue disease, such as Marfan syndrome. Extreme stress: Recent intense physical exertion, especially aerobic exercise, and emotional stress are common in many cases. Female sex: SCAD can happen to men, but women account for 80 to 90% of cases. Most women with SCAD are otherwise healthy and do not have risk factors for heart disease, such as high blood pressure or high cholesterol. Pregnancy: About one-third of SCAD cases happen during pregnancy or shortly after giving birth. Doctors speculate that changes in hormones or blood volume may play a role. Other possible risk factors include very high blood pressure that remains uncontrolled and cocaine use. Reducing your risk of spontaneous coronary artery dissection (SCAD) Because the exact cause of SCAD remains unclear, there are no known strategies of preventing the disease. It is also difficult to identify the problem before a heart attack occurs. If you have a disease that is linked to SCAD, talk with your doctor about your risk. Do not hesitate to seek medical care for unusual symptoms or symptoms of a heart attack, even if your risk of heart disease is low (such as normal blood pressure and cholesterol and no history of smoking). How is spontaneous coronary artery dissection (SCAD) treated? Treating SCAD is different from treating a typical heart attack due to atherosclerosis. Treatment can be more complex than other types of heart attack as well. Treatment options depend on the size and location of the tear, along with the amount of blockage. When blood flow is stable, doctors usually opt for conservative medical management. It has better outcomes compared to percutaneous coronary intervention (PCI). PCI—or angioplasty—is a catheter-based procedure to reopen blocked coronary arteries. The success rate in SCAD is much lower than with atherosclerotic heart attack. Only 62% of SCAD patients have favorable outcomes with PCI compared to 92% of typical heart attack patients. The risk of complications is also higher in SCAD. However, PCI or bypass surgery may be necessary in a SCAD heart attack if the artery is completely blocked or blood flow is unstable. The goal of medical management is to allow the artery to heal on its own. This is the preferred treatment if possible. It involves several days of monitoring in the hospital. Doctors may prescribe anticoagulants and medications to control blood pressure and chest pain. After hospital discharge, cardiac rehabilitation is important for recovery. It can help manage any ongoing symptoms and make it easier to return to everyday life. What are the potential complications of spontaneous coronary artery dissection (SCAD)? SCAD can recur and recurrence is one of the main complications. The recurrence rate is around 20%. The timing of recurrence can range from a few days to several years. When SCAD happens again, it usually involves a different artery. Having fibromuscular dysplasia seems to increase the risk of a second SCAD heart attack. However, there is no way to predict or prevent a recurrence. Other complications include heart failure and recurrent chest pain. More than half of women experience recurring chest pain, which is often linked to their menstrual cycle. SCAD is fatal in 3 to 11% of cases.