Spontaneous coronary artery dissection (SCAD) (2024)

What is spontaneous coronary artery dissection?

Spontaneous Coronary Artery Dissection (SCAD) is a tear in an artery wall in your heart that allows blood to build up in the space between the layers of your artery wall. This leads to a reduction or blockage of blood flow to your heart, which causes damage to your heart muscle and affects your heart rhythm. Reduced blood flow could cause a heart attack or cardiac arrest (cardiopulmonary arrest).

Who is at risk?

Ninety percent of SCAD cases are women, mostly between 30- 60 years old. SCAD accounts for about 25% of all heart attacks in women under 60 years old.

Other risk factors include:

  • fibromuscular dysplasia (FMD)
  • connective tissue disorders
  • systemic inflammations
  • cocaine use
  • severe emotional stress
  • intense physical exertion
  • hormonal therapy with estrogen & progesterone

Pregnant and post-partum women are also at risk of SCAD. The strain of pregnancy and labour can add to the stress on weaker blood vessels, leading to a tear. P-SCAD is a very rare pregnancy-associated SCAD that could lead to a heart attack if not treated as soon as symptoms appear.

Causes

The cause of SCAD is still unknown. It is believed that it starts with your artery wall weakening. Possible causes of weakened artery walls are:

  • fibromuscular dysplasia
  • genetics
  • multiple pregnancies
  • connective tissue disorders
  • systemic inflammations (like Crohn’s disease)
  • hormonal changes/therapy
  • cocaine use

SCAD can also be triggered by highly emotional events (death of loved one, job loss, breakdown of marriage) or physical stresses (giving birth, weight lifting, intensive workout, straining bowel movement, coughing, retching/vomiting,). In a recent study, more than half of patients experienced an emotionally or physically stressful event around the time of their SCAD.

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Symptoms

If you experience a SCAD episode you may have these symptoms:

  • chest pain, pressure, tightness or heaviness
  • rapid heartbeat, fluttery feeling
  • pain in arms, shoulders, jaw, neck, back or stomach
  • excessive sweating
  • unusual/extreme exhaustion
  • nausea, vomiting
  • dizziness/lightheadedness
  • fainting/loss of consciousness
  • headache
Diagnosis

SCAD is not widely understood and is often misdiagnosed. First, an echocardiogram will be done to check your heart activity. A doctor will also look to see if you have elevated troponin levels in your blood. This is a protein found following damage to your heart.

An imaging test called coronary angiogram will give your doctor an idea of the location of the tear and its measurements. If you are pregnant this test may not be safe for the fetus. Sometimes, further imaging with optical coherence tomography (OCT) or an intravascular ultrasound (IVUS) may be necessary to help diagnosis.

Your doctor may also perform a multidetector computed tomography scan (MDCT) to provide a detailed image of your heart.

Listen to your body and never stop asking questions. If you don’t like the answers you get, ask someone else.

Melanie Demmer

SCAD survivor

Treatment

Managing SCAD will depend on the location and length of your tear and the damage done to your artery, with the hope that your artery will heal itself. SCAD treatment is usually conservative because surgery and aggressive treatments can be high risk. Treatment options may include:

  • controlling blood pressure
  • beta-blockers
  • ACE inhibitors
  • ASA (aspirin)
  • cardiac rehabilitation

Sometime after four to six weeks, another angiogram may help your healthcare team to understand if anything else needs to be done. SCAD recurrences are common (20%) so you should have frequent check-ups with your doctor. It is usually recommended that you take ASA (Aspirin) and beta-blockers long-term to help manage your heart health.

Surgery and other procedures

Sometimes medications and lifestyle changes may not work for you and surgery is needed. This could happen if the tear is too extensive or is near an important part of the heart. If you continue to have symptoms or remain unstable you may also need one of these procedures:

  • angioplasty/ percutaneous coronary intervention (PCI)
  • implanted defibrillator
  • coronary artery bypass grafting (CABG)

Lifestyle and ongoing care

Lifestyle changes that may prevent SCAD from recurring include:

  • avoiding emotional stress
  • regular exercise, without intense weight lifting or competitive sports
  • achieving a healthy weight and diet to manage blood pressure
  • pregnancy might be discouraged because of the risk of peripartum SCAD or P-SCAD
  • cardiac rehabilitation
Living with SCAD

It’s normal to feel worried or afraid after a diagnosis of heart disease. Find someone you can turn to for emotional support like a family member, friend, doctor, mental health worker or support group. Talking about your challenges and feelings could be an important part of your journey to recovery.

There are support groups and online communities you can join to help you cope with the effects of SCAD and connect with other survivors:

Spontaneous coronary artery dissection (SCAD) (1)

Sudi’s experience with SCAD made her an advocate for more accurate diagnosis

Read her story

Spontaneous coronary artery dissection (SCAD) (2)
Research

Research is underway to better understand SCAD and to develop new treatments.

A Heart and Stroke funded SCAD study will look at the connection between SCAD and genetics. It aims to advance women’s heart health by learning more about potential genetic markers that could indicate SCAD.

There is another study underway that will look at the connection between SCAD and medical conditions that result in changes to the arteries. This study hopes to improve the diagnosis of SCAD and help doctors better understand related conditions. Learn more about this exciting Canadian SCAD study here.

Related information

Uncovering the Mystery of SCAD

Learn more about women’s unique risk factors.

Spontaneous coronary artery dissection (SCAD) (2024)

FAQs

What is the survival rate for SCAD? ›

Outlook / Prognosis

SCAD can be life-threatening, claiming the lives of up to 5% of people who develop it.

What is spontaneous coronary artery dissection SCAD? ›

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.

What is the most common cause of SCAD? ›

The causes of SCAD are unclear. SCAD mainly affects young, healthy people who have few or none of the typical risks for heart disease, such as diabetes, smoking, high cholesterol or obesity. Common factors and potential triggers for SCAD include: Being female – SCAD tends to affect more women than men.

What does SCAD feel like? ›

That's why recognizing the symptoms of a heart attack is crucial for SCAD patients. Warning signs may include chest pain or pressure, shortness of breath, profuse sweating and dizziness.

Can you live a normal life after SCAD? ›

If SCAD is diagnosed quickly and treated properly, most people will have a full recovery. Patients will need regular follow-up appointments with their cardiologist to monitor their condition.

Is SCAD caused by stress? ›

SCAD can also be triggered by highly emotional events (death of loved one, job loss, breakdown of marriage) or physical stresses (giving birth, weight lifting, intensive workout, straining bowel movement, coughing, retching/vomiting,).

How long does it take to recover from a spontaneous coronary artery dissection? ›

Your care team will do tests and watch for more symptoms or problems. You may stay in the hospital for a few days. The condition that caused the blood to pool in the layers of the artery wall often heals itself within weeks or months.

What should you avoid after a SCAD? ›

Dr Adlam discusses exercise after SCAD

Do with caution: High endurance aerobic training, muscle-building exercises or Yoga poses involving extreme head/neck positions. Avoid: High-intensity exercise, contact sports and extreme head positions.

What is the best treatment for a SCAD? ›

Medical Therapy

A percentage of SCAD events involve intimal tears that are prothrombotic and would likely benefit from antiplatelet therapy. Therefore, we typically administer aspirin and clopidogrel for acute SCAD patients and follow-up with clopidogrel for 1 year and aspirin for life.

Does SCAD go away on its own? ›

Treatment may include medicines and a procedure or surgery to open the artery and restore blood flow. Sometimes SCAD heals on its own. The type of treatment for SCAD depends on your overall health and the size and location of the tear in the artery.

Is SCAD an autoimmune disease? ›

Case reports and referral-based studies suggest spontaneous coronary artery dissection (SCAD) is associated with autoimmune diseases and causes 2% to 4% of acute coronary syndromes.

Does SCAD run in families? ›

Importance Spontaneous coronary artery dissection (SCAD) is a poorly understood cause of acute coronary syndrome that predominantly affects women. Evidence to date suggests a complex genetic architecture, while a family history is reported for a minority of cases.

What is the life expectancy of someone with SCAD? ›

Based on 750 consecutive SCAD patients who had presented with heart attacks and were largely treated conservatively, long-term survival was "excellent" given a 3-year mortality rate of just 0.8%, according to Jacqueline Saw, MD, of Vancouver General Hospital, and colleagues of the Canadian SCAD (CanSCAD) cohort study.

Does SCAD show up on an EKG? ›

Tests to diagnose heart attacks and SCAD include: ECG (electrocardiogram) – although ECGs can look normal in some SCAD patients. Blood tests to assess Troponin levels. (Troponin is a protein that is released into the blood during a heart attack – read more in the FAQ below)

How do doctors test for SCAD? ›

Cardiac catheterization: An angiogram is the most common test for diagnosing SCAD. If appropriate, our doctors will use an intravascular ultrasound (IVUS) or optical coherence tomography screening (OCT) to directly look inside the affected vessel(s). CT coronary angiogram.

How often is SCAD fatal? ›

Prognosis. People with SCAD have a low in-hospital mortality after treatment. However, the lesion may worsen after leaving the hospital within the first month. One study suggested a 1.2% mortality rate following SCAD but a 19.9% risk for either death, heart attacks, or strokes.

What is the success rate of SCAD surgery? ›

In a large Vancouver cohort of 327 patients with SCAD, 54 were treated with PCI; only 43.1% of procedures were deemed successful.

What is the success rate of SCAD? ›

The SCAD overall six-year graduation rate is 74% for female students and 65% for male students.

Can you recover from SCAD? ›

Treatment may include medicines and a procedure or surgery to open the artery and restore blood flow. Sometimes SCAD heals on its own. The type of treatment for SCAD depends on your overall health and the size and location of the tear in the artery.

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